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General NPI Number Information
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NPI Number | 1538884549
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Entity Type | Organization
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Legal Business Name | KELLY A BLASKO PHD LLC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1615 N STEVENS ST
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City | TACOMA
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State | WA
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Zip | 98406-3827
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Country | US
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Telephone | 253-247-4288
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 N. 27TH ST. #6844
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City | TACOMA
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State | WA
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Zip | 98407
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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. KELLY BLASKO
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Credential | PH.D, LP
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Telephone | 253-247-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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