Provider Demographics
NPI:1861835969
Name:BLAKLEY, EMILIE ROSE (LMP)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:ROSE
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 INLOW LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-9309
Mailing Address - Country:US
Mailing Address - Phone:509-868-5944
Mailing Address - Fax:
Practice Address - Street 1:52 INLOW LOOP RD
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9309
Practice Address - Country:US
Practice Address - Phone:509-868-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60354535172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker