Provider Demographics
NPI:1285045104
Name:BLAKLEY, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLAKLEY
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 1:7000 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1820
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:916-388-9273
Practice Address - Street 1:7000 FRANKLIN BLVD SIITE 625
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2006
Practice Address - Country:US
Practice Address - Phone:916-388-9418
Practice Address - Fax:916-388-9273
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherSERVICES TO DRUG MEDI-CAL CLIENTS