MEDICARE: DR. WILLIAM A. BLAKEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1146	OR
2	103T00000X	Psychologist	1146	OR

General Provider Information

NPI Number	:	1497859888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A. BLAKEY PH.D.

Provider Business Mailing Address
First Line	:	10931 SE CEDAR WAY
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086
Country	:	US
Telephone Number	:	503-698-4212
Fax Number	:	503-659-1994

Provider Business Practice Location Address
First Line	:	880 82ND DR
Second Line	:
City	:	GLADSTONE
State	:	OR
Zip	:	97027-1803
Country	:	US
Telephone Number	:	503-659-5515
Fax Number	:	503-659-1994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	11/21/2024

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