Provider Demographics
NPI:1174744361
Name:STATON, BLANCHE (BSW)
Entity type:Individual
Prefix:MRS
First Name:BLANCHE
Middle Name:
Last Name:STATON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:KENTUCKY
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-836-3803
Mailing Address - Fax:606-836-3803
Practice Address - Street 1:1105 FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:KENTUCKY
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-836-3803
Practice Address - Fax:606-836-3803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker