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General NPI Number Information
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NPI Number | 1962720177
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Entity Type | Individual
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Provider Name | BLAKELY J WERNER PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 07/03/2010
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Provider Practice Location Address
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Address Line | 930 170TH PL SE
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City | BELLEVUE
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State | WA
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Zip | 98008-5237
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Country | US
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Telephone | 425-746-5315
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Fax | 425-458-7921
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Provider Business Mailing Address
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Address Line | 930 170TH PL SE
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City | BELLEVUE
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State | WA
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Zip | 98008-5237
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Country | US
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Telephone | 425-746-5315
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Fax |
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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 | PY60078973
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License Number State | WA
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