Provider Demographics
NPI:1073406070
Name:BLANKS, JASON CHAD (MS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHAD
Last Name:BLANKS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 WASHINGTON AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7141
Mailing Address - Country:US
Mailing Address - Phone:616-499-2218
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE STE 600
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7141
Practice Address - Country:US
Practice Address - Phone:616-499-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician