Provider Demographics
NPI:1659588572
Name:BIALOCK, RICK SAMUEL (MA, CDP)
Entity Type:Individual
Prefix:MRS
First Name:RICK
Middle Name:SAMUEL
Last Name:BIALOCK
Suffix:
Gender:M
Credentials:MA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20174 FRONT ST NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7445
Mailing Address - Country:US
Mailing Address - Phone:360-697-7721
Mailing Address - Fax:360-697-7737
Practice Address - Street 1:9095 MCCONNELL AVE NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8392
Practice Address - Country:US
Practice Address - Phone:360-698-7267
Practice Address - Fax:360-698-5967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18047501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991124Medicaid