Healthcare Provider Details

I. General information

NPI: 1992851166
Provider Name (Legal Business Name): LINDA LEE BLOHM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 W MICHIGAN AVE SUITE 301A
LANSING MI
48917-3693
US

IV. Provider business mailing address

911 MAPLEHILL AVE
LANSING MI
48910-4718
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-1209
  • Fax:
Mailing address:
  • Phone: 517-394-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061672
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: