MEDICARE: BLANCHE E WASHINGTON M.ED.

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
1	103K00000X	Behavior Analyst

Other Identifiers

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

General Provider Information

NPI Number	:	1184966640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCHE E WASHINGTON M.ED.

Provider Business Mailing Address
First Line	:	2200 NW 119TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7817
Country	:	US
Telephone Number	:	405-751-4162
Fax Number	:	405-751-4162

Provider Business Practice Location Address
First Line	:	2200 NW 119TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7817
Country	:	US
Telephone Number	:	405-751-4162
Fax Number	:	405-751-4162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/22/2013

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