Provider Demographics
NPI:1790977353
Name:BLUNK, KELLY MAUREEN (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MAUREEN
Last Name:BLUNK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4502 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1817
Mailing Address - Country:US
Mailing Address - Phone:602-764-1100
Mailing Address - Fax:602-407-1159
Practice Address - Street 1:3333 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3403
Practice Address - Country:US
Practice Address - Phone:602-764-3000
Practice Address - Fax:602-452-5825
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3842151103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool