SHAWN THORNTON BLAKLEY MSE CADCIII NPI 1417022468

NPI Information

NPI: 1417022468
Provider Name: SHAWN THORNTON BLAKLEY, MSE, CADCIII
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

PECOS Registration: Yes

Address:
130 E WALNUT ST
SUITE 706
GREEN BAY, WI
ZIP 54301
Phone: (920) 437-8256
Get Directions

Shawn Thornton Blakley, MSE, CADCIII is an addiction (substance use disorder) counselor in Green Bay, WI with 33 years of experience. Shawn Thornton Blakley, MSE, CADCIII NPI is 1417022468. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

130 E WALNUT ST
SUITE 706
GREEN BAY, WI
ZIP 54301-239
Phone: (920) 437-8256
Fax: (920) 437-1188

The NPI 1417022468 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/22/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CADCIII	WISCONSIN	Yes
2	101YP2500X	Counselor	Professional	792-125	WISCONSIN	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	39626900	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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