Individual
DR. BRENT BLAISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4403 HARRISON BLVD, SUITE A-700, OGDEN, UT 84403-3271
(801) 387-5300
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-5300
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
273961-3902
UT
Other
Enumeration date
10/08/2014
Last updated
02/03/2015
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