Individual
MRS. SHANNON L BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
6320 N 82ND ST, SCOTTSDALE, AZ 85250-5611
(408) 484-3100
(408) 484-3101
Mailing address
6320 N 82ND ST, SCOTTSDALE, AZ 85250-5611
(408) 484-3100
(408) 484-3101
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
625840
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
01/31/2007
Last updated
07/26/2007
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