Healthcare Provider Details

I. General information

NPI: 1376867614
Provider Name (Legal Business Name): SPENCER FIELDING BLALOCK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

PO BOX 2413
GRAND JUNCTION CO
81502-2413
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax: 206-901-2010
Mailing address:
  • Phone: 601-480-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW61503960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: