Provider Demographics
NPI:1760931935
Name:BLAZEK, KATHLEEN (DACM)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BLAZEK
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 BRIARGATE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4188
Mailing Address - Country:US
Mailing Address - Phone:719-357-9448
Mailing Address - Fax:719-960-2439
Practice Address - Street 1:3475 BRIARGATE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4188
Practice Address - Country:US
Practice Address - Phone:719-357-9448
Practice Address - Fax:719-960-2439
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist