Individual
LEANNA LOUISE BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA2
Contact information
Practice address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-3851
Mailing address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-7720
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
23-QMHA-R-4729
OR
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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