Provider Demographics
NPI:1083141253
Name:STEMPLE, BLAYNE D
Entity Type:Individual
Prefix:
First Name:BLAYNE
Middle Name:D
Last Name:STEMPLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 NE 183RD ST UNIT 313
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7073
Mailing Address - Country:US
Mailing Address - Phone:479-422-7396
Mailing Address - Fax:
Practice Address - Street 1:4909 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4107
Practice Address - Country:US
Practice Address - Phone:206-987-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60906696103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst