Provider Demographics
NPI:1871965525
Name:BLAMER, NICOLE C (LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:BLAMER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2836
Mailing Address - Country:US
Mailing Address - Phone:740-507-1284
Mailing Address - Fax:
Practice Address - Street 1:114 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2324
Practice Address - Country:US
Practice Address - Phone:419-562-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.11016381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical