Provider Demographics
NPI:1194478263
Name:BLONDEK, STANLEY KUHIO (PSYD, LAADC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:KUHIO
Last Name:BLONDEK
Suffix:
Gender:M
Credentials:PSYD, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 AUBURN BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4103
Mailing Address - Country:US
Mailing Address - Phone:916-830-2224
Mailing Address - Fax:
Practice Address - Street 1:4300 AUBURN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4103
Practice Address - Country:US
Practice Address - Phone:916-830-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI04950320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)