Provider Demographics
NPI:1629352190
Name:BLODGETT, VANESSA JONE
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:JONE
Last Name:BLODGETT
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 1:1277 LULLABROOKE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-3738
Mailing Address - Country:US
Mailing Address - Phone:775-303-3182
Mailing Address - Fax:
Practice Address - Street 1:10880 DEODAR WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-9064
Practice Address - Country:US
Practice Address - Phone:775-786-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst