Provider Demographics
NPI:1053918821
Name:OBERHEUSER, BLAKE MARIE
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:MARIE
Last Name:OBERHEUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W PEPPERTREE WAY
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1955
Mailing Address - Country:US
Mailing Address - Phone:719-238-8700
Mailing Address - Fax:
Practice Address - Street 1:454 W PEPPERTREE WAY
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1955
Practice Address - Country:US
Practice Address - Phone:719-238-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool