Provider Demographics
NPI:1619448586
Name:HASSELBLAD, ERIC ROBERT
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:HASSELBLAD
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:PO BOX 2906
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-2906
Mailing Address - Country:US
Mailing Address - Phone:509-290-3411
Mailing Address - Fax:
Practice Address - Street 1:601 W FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3518
Practice Address - Country:US
Practice Address - Phone:360-462-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health