Individual
DR. MICHELLE BLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
Mailing address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
35SI00757700
NJ
103TC0700X
Clinical Psychologist
203-032
NJ
Other
Enumeration date
09/03/2020
Last updated
01/16/2025
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