Provider Demographics
NPI:1710009618
Name:BLAIR, ALLEN J
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:J
Last Name:BLAIR
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 1:1675 C ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5115
Mailing Address - Country:US
Mailing Address - Phone:907-274-8281
Mailing Address - Fax:907-274-4055
Practice Address - Street 1:1675 C ST
Practice Address - Street 2:SUITE 117
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5115
Practice Address - Country:US
Practice Address - Phone:907-274-8281
Practice Address - Fax:907-274-4055
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical