Provider Demographics
NPI:1124573779
Name:BLANCHARD, CHAD ANTHONY
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ANTHONY
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 1972
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1972
Mailing Address - Country:US
Mailing Address - Phone:530-588-2632
Mailing Address - Fax:530-894-5971
Practice Address - Street 1:344 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4814
Practice Address - Country:US
Practice Address - Phone:530-588-2632
Practice Address - Fax:541-625-4644
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health