Individual
ALONDA BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1810 E 15TH ST STE A, TULSA, OK 74104-4611
(918) 410-9668
Mailing address
1810 E 15TH ST STE A, TULSA, OK 74104-4611
(918) 410-9668
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SSB005710
—
OK
Enumeration date
06/21/2022
Last updated
06/21/2022
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