Individual
DR. TICIA ANN BLANCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
#70 ESTES AVE., WHITE SALMON, WA 98672
(541) 490-7045
(805) 544-1412
Mailing address
600 REDONDO CT, GROVER BEACH, CA 93433-2931
(541) 490-7045
(805) 544-1412
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00003284
WA
Other
Enumeration date
05/02/2008
Last updated
05/02/2008
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