# CHARLENE BLANCHARD KALLUSCH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538359179
- **Gender:** F
- **Credential:** PSY.D

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | PY61400544 | WA | Yes |
| 103TC0700X | Clinical Psychologist | PSY24134 | CA | — |

## Other

- **Enumeration date:** 07/30/2007
- **Last updated:** 09/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01CR | MEDI-CAL | CA |