Provider Demographics
NPI:1568486942
Name:BLODGETT, ZANE ANDREW (LCSW)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:ANDREW
Last Name:BLODGETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 SW WANAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1347
Mailing Address - Country:US
Mailing Address - Phone:785-478-9170
Mailing Address - Fax:
Practice Address - Street 1:4037 WANAMAKER STREET
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66610
Practice Address - Country:US
Practice Address - Phone:785-478-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0025271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical