Individual
DR. JONATHAN W BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
11059 E BETHANY DR, AURORA, CO 80014-2622
(303) 617-2392
Mailing address
11059 E BETHANY DR, AURORA, CO 80014-2622
(303) 617-2392
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2444
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88623769
—
CO
Enumeration date
10/24/2006
Last updated
07/08/2007
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