Provider Demographics
NPI:1114068855
Name:DUNN, POLLY BLAKE (PHD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:BLAKE
Last Name:DUNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SKYWAY DR
Mailing Address - Street 2:SUITE 801
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7137
Mailing Address - Country:US
Mailing Address - Phone:334-742-9102
Mailing Address - Fax:334-742-9103
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:SUITE 801
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-742-9102
Practice Address - Fax:334-742-9103
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504767OtherBCBS OF ALA. PROVIDER #
AL631284611OtherTAX ID NUMBER