Individual
DR. STEPHEN L BLAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
125 CRESTRIDGE ST, FORT COLLINS, CO 80525-3934
(970) 494-4200
Mailing address
2912 EINDBOROUGH DR, FORT COLLINS, CO 80525-2363
(970) 988-6972
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY.0003207
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89678257
—
CO
01
—
COA105768
MEDICARE PTAN
CO
Enumeration date
08/29/2006
Last updated
07/21/2022
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