Individual
SHAWN THORNTON BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSE, CADCIII
Contact information
Practice address
130 E WALNUT ST, SUITE 706, GREEN BAY, WI 54301-4239
(920) 437-8256
(920) 437-1188
Mailing address
130 E WALNUT ST, SUITE 706, GREEN BAY, WI 54301-4239
(920) 437-8256
(920) 437-1188
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADCIII
WI
101YP2500X
Professional Counselor
792-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39626900
—
WI
Enumeration date
11/22/2006
Last updated
09/11/2025
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