Healthcare Provider Details

I. General information

NPI: 1679820948
Provider Name (Legal Business Name): BLAIR NICOLE SONS M.A.,P.P.S.,B.C.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E WASHINGTON AVE
REEDLEY CA
93654-3595
US

IV. Provider business mailing address

5290 E DWIGHT WAY
FRESNO CA
93727-5988
US

V. Phone/Fax

Practice location:
  • Phone: 559-305-7130
  • Fax:
Mailing address:
  • Phone: 559-287-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-7994
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: