Provider Demographics
NPI:1245608629
Name:BLANCHARD, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97344-0237
Mailing Address - Country:US
Mailing Address - Phone:503-787-4514
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST STE 333
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator