Individual
BLAISE DENNIS MAXWELL SCOLLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.M.A.CCC
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-3820
(503) 571-5838
Mailing address
PO BOX 82608, PORTLAND, OR 97282-0608
(503) 571-3820
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10394
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28605
—
OR
Enumeration date
10/23/2006
Last updated
05/01/2013
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