Provider Demographics
NPI:1669856696
Name:BLAU, KATHRYN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BLAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 ARAPAHOE RD UNIT B-276
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6013
Mailing Address - Country:US
Mailing Address - Phone:408-489-9219
Mailing Address - Fax:
Practice Address - Street 1:3336 ARAPAHOE RD UNIT B-276
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6013
Practice Address - Country:US
Practice Address - Phone:720-551-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26512103T00000X
COPSY.0004797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist