Provider Demographics
NPI:1104405760
Name:BLANKENSHIP, ELLEN ABRAMS (MS, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ABRAMS
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 N ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1416
Mailing Address - Country:US
Mailing Address - Phone:414-750-0263
Mailing Address - Fax:
Practice Address - Street 1:4326 N ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1416
Practice Address - Country:US
Practice Address - Phone:414-750-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1172-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional