Provider Demographics
NPI:1710548359
Name:BLAIR, KATHRYN (MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BEACH ROAD 2105 HIXSON-LIED STUDENT SUCCESS CENTER
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-0001
Mailing Address - Country:US
Mailing Address - Phone:515-294-7081
Mailing Address - Fax:515-294-2697
Practice Address - Street 1:215 BEACH ROAD 2105 HIXSON-LIED STUDENT SUCCESS CENTER
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-0001
Practice Address - Country:US
Practice Address - Phone:515-294-7081
Practice Address - Fax:515-294-2697
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health