Individual
JACOB MICHAEL BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
32841 MIDDLEBELT RD STE 403, FARMINGTON HILLS, MI 48334-1714
(248) 851-7739
Mailing address
1085 KENYON DR, FORT WASHINGTON, PA 19034-1625
(215) 816-1395
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6352001031
MI
Other
Enumeration date
10/30/2024
Last updated
10/30/2024
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