Individual
KRISSY BLANDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP
Contact information
Practice address
1014 W RUSH RD, EAGLE, ID 83616-3620
(208) 921-1809
Mailing address
1014 W RUSH RD, EAGLE, ID 83616-3620
(208) 921-1809
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/25/2015
Last updated
09/25/2015
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