Individual
BLAKE ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
870 S FRONT ST STE 200, CENTRAL POINT, OR 97502-2779
(541) 732-8000
Mailing address
711 MEDFORD CTR # 132, MEDFORD, OR 97504-6772
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3910
OR
Other
Enumeration date
12/06/2024
Last updated
12/06/2024
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