Provider Demographics
NPI:1679239529
Name:BLAYLOCK, ARIEANNA M
Entity type:Individual
Prefix:
First Name:ARIEANNA
Middle Name:M
Last Name:BLAYLOCK
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 1:1400 W MARINE DR APT 28
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5618
Mailing Address - Country:US
Mailing Address - Phone:971-601-0117
Mailing Address - Fax:
Practice Address - Street 1:407 N COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3117
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:541-264-7515
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator