Individual
GERALD BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
414 FRONT ST N, ISSAQUAH, WA 98027-2914
(425) 392-6367
Mailing address
414 FRONT ST N, ISSAQUAH, WA 98027-2914
(425) 392-6367
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00003663
WA
Other
Enumeration date
11/03/2016
Last updated
11/03/2016
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