| Katie Blake, LCSW | |
|
2225 Challenger Way, Santa Rosa, CA 95407-5441 | |
| (707) 483-0588 | |
| Not Available |
| Full Name | Katie Blake |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 2225 Challenger Way, Santa Rosa, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104375393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 93792 (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Katie Blake, LCSW 1275 4th St # 4011, Santa Rosa, CA 95404-4057 Ph: (707) 908-9790 | Katie Blake, LCSW 2225 Challenger Way, Santa Rosa, CA 95407-5441 Ph: (707) 483-0588 |
Mrs. Erin O. Liiv, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1300 N Dutton Ave, Santa Rosa, CA 95401 Phone: 707-303-3600 |
Ms. Lynnette J Cromwell, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 327 College Ave, Santa Rosa, CA 95401 Phone: 707-568-2800 Fax: 707-568-2804 |
Cristina Corey Schroen, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 401 Bicentennial Way, Santa Rosa, CA 95403 Phone: 707-571-2536 |
Felicia Reynolds, Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 341 Irwin Ln, Santa Rosa, CA 95401 Phone: 707-360-1500 |
Karen Helene Littell, MSW, LCSW, PPSC Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 862 3rd St, Santa Rosa, CA 95404 Phone: 707-536-1206 |
Marcelle Dominguez, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 576 B St, Suite 1-b, Santa Rosa, CA 95401 Phone: 707-339-0398 |
Mr. Michael Glenn Ostash, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3841 Brickway Blvd, Santa Rosa, CA 95403 Phone: 707-569-2300 |