Organization
CHERYL BLANK, PH.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL RAE BLANK PH.D. (PSYCHOLOGIST)
(406) 587-7468
Entity
Organization
Contact information
Practice address
121 W KAGY BLVD, BOZEMAN, MT 59715-6000
(406) 587-7468
Mailing address
4744 ITANA CIR, BOZEMAN, MT 59715-9330
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
202
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000490807
—
MT
01
—
000085292
264349
MT
01
—
52820
BLUE CROSS
MT
Enumeration date
08/14/2007
Last updated
08/14/2007
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