Provider Demographics
NPI:1902245905
Name:BLANKENSHIP, GWENDOLYN K (LCSW)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:K
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:K
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:344 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1651
Practice Address - Country:US
Practice Address - Phone:717-738-1125
Practice Address - Fax:717-738-0606
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040521041C0700X
PACW0183151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103626033Medicaid
12571606OtherCAQH
VAC06778OtherGROUP PTAN
PACW018315OtherSTATE LICENSE