Basic Information
| Provider Information | |||||||||
| NPI: | 1174297766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLIKKEN | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7300 E INDIANA ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124018008 | ||||||||
| FaxNumber: | 8124018201 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 EAST INDIANA STREET | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124018008 | ||||||||
| FaxNumber: | 8124018201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34007938A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.