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General NPI Number Information
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NPI Number | 1699941369
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Entity Type | Individual
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Provider Name | TICIA ANN BLANCK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | #70 ESTES AVE.
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City | WHITE SALMON
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State | WA
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Zip | 98672
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Country | US
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Telephone | 541-490-7045
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Fax | 805-544-1412
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Provider Business Mailing Address
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Address Line | 600 REDONDO CT
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City | GROVER BEACH
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State | CA
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Zip | 93433-2931
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Country | US
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Telephone | 541-490-7045
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Fax | 805-544-1412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PY00003284
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License Number State | WA
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