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NPI Code Detail

MEDICARE: DR. STEPHEN L BLAD PHD

MEDICARE: DR. STEPHEN L BLAD PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY.0003207CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1COA105768OTHERCOMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144339821
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN L BLAD PHD
Provider Business Mailing Address
First Line : 2912 EINDBOROUGH DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-2363
Country : US
Telephone Number : 970-988-6972
Fax Number :
Provider Business Practice Location Address
First Line : 125 CRESTRIDGE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3934
Country : US
Telephone Number : 970-494-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 07/21/2022

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