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General NPI Number Information
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NPI Number | 1518159433
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Entity Type | Organization
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Legal Business Name | CHERYL BLANK, PH.D., P.C.
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 121 W KAGY BLVD
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City | BOZEMAN
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State | MT
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Zip | 59715-6000
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Country | US
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Telephone | 406-587-7468
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Fax |
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Provider Business Mailing Address
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Address Line | 4744 ITANA CIR
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City | BOZEMAN
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State | MT
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Zip | 59715-9330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CHERYL RAE BLANK
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Credential | PH.D.
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Telephone | 406-587-7468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 202
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License Number State | MT
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