Provider Demographics
NPI:1184966640
Name:WASHINGTON, BLANCHE E (MED)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:E
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NW 119TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7817
Mailing Address - Country:US
Mailing Address - Phone:405-751-4162
Mailing Address - Fax:405-751-4162
Practice Address - Street 1:2200 NW 119TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7817
Practice Address - Country:US
Practice Address - Phone:405-751-4162
Practice Address - Fax:405-751-4162
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKASCX12Medicaid