Provider Demographics
NPI:1821107087
Name:BLAIR, ANITA S (PSYD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2927
Mailing Address - Country:US
Mailing Address - Phone:316-634-4700
Mailing Address - Fax:316-634-4770
Practice Address - Street 1:9333 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2927
Practice Address - Country:US
Practice Address - Phone:316-634-4700
Practice Address - Fax:316-634-4770
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002967103G00000X
KS2740103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8805931Medicare UPIN