Individual
HOLLY BLALACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12540 SW MAIN ST STE 202, TIGARD, OR 97223-6198
(503) 906-9995
Mailing address
12540 SW MAIN ST STE 202, TIGARD, OR 97223-6198
(503) 906-9995
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
18-CRM-045
OR
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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