Provider Demographics
NPI:1174690325
Name:BLALOCK, MELENEE D
Entity Type:Individual
Prefix:MS
First Name:MELENEE
Middle Name:D
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2120
Mailing Address - Country:US
Mailing Address - Phone:907-231-7739
Mailing Address - Fax:907-332-0809
Practice Address - Street 1:4010 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2120
Practice Address - Country:US
Practice Address - Phone:907-231-7739
Practice Address - Fax:907-332-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM19751Medicaid