MEDICARE: BLAIR NICOLE SONS M.A.,P.P.S.,B.C.B.A

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	103K00000X	Behavior Analyst	1-11-7994	CA
2	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1679820948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR NICOLE SONS M.A.,P.P.S.,B.C.B.A

Provider Business Mailing Address
First Line	:	5290 E DWIGHT WAY
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-5988
Country	:	US
Telephone Number	:	559-287-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 E WASHINGTON AVE
Second Line	:
City	:	REEDLEY
State	:	CA
Zip	:	93654-3595
Country	:	US
Telephone Number	:	559-305-7130
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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