Healthcare Provider Details

I. General information

NPI: 1083790133
Provider Name (Legal Business Name): NANCY E BLOCK-OLEXICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 STEVENSON AVE SUITE 206
ENUMCLAW WA
98022-2647
US

IV. Provider business mailing address

PO BOX 217
BUCKLEY WA
98321-0217
US

V. Phone/Fax

Practice location:
  • Phone: 253-307-9851
  • Fax:
Mailing address:
  • Phone: 253-307-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1839
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: