Individual
BLAKE BETTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1750 FORDEM AVE APT 704, MADISON, WI 53704-7135
(470) 331-2534
Mailing address
1750 FORDEM AVE APT 704, MADISON, WI 53704-7135
(470) 331-2534
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5124-57
WI
Other
Enumeration date
06/25/2024
Last updated
06/25/2024
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