Provider Demographics
NPI:1598139438
Name:ROBERTS BLAKEMAN, KIM (IADC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:ROBERTS BLAKEMAN
Suffix:
Gender:
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2306
Mailing Address - Country:US
Mailing Address - Phone:515-280-3860
Mailing Address - Fax:
Practice Address - Street 1:1300 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2306
Practice Address - Country:US
Practice Address - Phone:515-280-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA68236OtherWELLMARK
IA0177394Medicaid