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NPI Code Detail

MEDICARE: DR. TERESA JANE BLAKELY PH.D.

MEDICARE: DR. TERESA JANE BLAKELY 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
1103TC0700XClinical Psychologist3470OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1401660OTHEROHVALUE OPTIONS PROVIDER ID

General Provider Information

NPI Number : 1699726828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA JANE BLAKELY PH.D.
Provider Business Mailing Address
First Line : 275 E LONGVIEW AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43202-1239
Country : US
Telephone Number : 614-262-8317
Fax Number : 614-262-5609
Provider Business Practice Location Address
First Line : 275 E LONGVIEW AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43202-1239
Country : US
Telephone Number : 614-262-8317
Fax Number : 614-262-5609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 12/06/2024

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