Most Relevant Information
Provider Data
| NPI Number: | 1003510769 |
| Provider Name: | BENJAMIN WILLIAM BLAIR R1499800323 |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 49-02 |
Most Important Dates
| Enumeration Date: | 03/28/2023 |
| Last Updated: | 03/28/2023 |
Provider Practice Location
625 STEELE LN
SANTA ROSA
CA
954033127
Practice Location Phone/Fax
| Phone: | 7075760818 |
| Fax: | 7075767845 |
Provider Mailing Location
625 STEELE LN
SANTA ROSA
CA
954033127
Provider Mailing Phone/Fax
| Phone: | 7075760818 |
| Fax: |