Eric John Blickenstaff, L.C.S.W.
Social Worker, Clinical in Corvallis, OR. Individual provider (NPI-1).
NPI number1366735227
StatusActive
Last updated in NPPESMay 25, 2011
Details
- NPI
- 1366735227
- Entity type
- Individual (NPI-1)
- Name
- Eric John Blickenstaff
- Credential
- L.C.S.W.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 25, 2011
- Last updated
- May 25, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | L4669 | OR | Yes |
Practice location
891 Nw Grant AveCorvallis, OR 97330-4539
Phone 503-708-6190
Mailing address
4067 Davidson St SeAlbany, OR 97322-6325
Phone 503-708-6190
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