Provider Demographics
NPI:1710355391
Name:BLANCHARD, PAUL (BA CADC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:BA CADC CANDIDATE
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:CHARLES
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16063 BONAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4149
Mailing Address - Country:US
Mailing Address - Phone:503-799-8218
Mailing Address - Fax:
Practice Address - Street 1:16063 BONAIRE AVE
Practice Address - Street 2:000
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4149
Practice Address - Country:US
Practice Address - Phone:503-799-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)