| Doctor Name: | MRS. JACKIE C BLAIR |
| NPI Number: | 1821274408 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED |
| License Number: | 86020236 |
| Business Practice Address: | 146 School Bus Lane Snowflake, AZ - 85937 |
| Business Phone Number: | 9285364156 |
| Business Fax Number: | |
| Mailing Address: | 177 E Meadowlark, SNOWFLAKE |
| State: | AZ |
| Postal Code: | 859375116 |
| Phone Number: | 9282431250 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2008 |
| NPI Last Update Date: | 01/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | 86020236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |