Provider Demographics
NPI:1730786716
Name:DOBBELMANN, BLAKE EDWARD
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:EDWARD
Last Name:DOBBELMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0259
Mailing Address - Country:US
Mailing Address - Phone:850-362-6824
Mailing Address - Fax:
Practice Address - Street 1:3355 ADDISON DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7065
Practice Address - Country:US
Practice Address - Phone:850-362-6824
Practice Address - Fax:850-626-6132
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-210733106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician