Provider Demographics
NPI:1427457829
Name:BLATNIK, DAN (LICSW)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:BLATNIK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SENECA STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:509-241-7195
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:3505 104TH PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4617
Practice Address - Country:US
Practice Address - Phone:425-259-5195
Practice Address - Fax:425-259-4554
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 601607741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical