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General NPI Number Information
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NPI Number | 1326090317
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Entity Type | Organization
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Legal Business Name | CHARLES BLONS, PLLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 9001 E BLOOMINGTON FWY SUITE 139
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City | BLOOMINGTON
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State | MN
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Zip | 55420-3435
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Country | US
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Telephone | 952-881-6797
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Fax | 952-881-2028
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Provider Business Mailing Address
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Address Line | 9001 E BLOOMINGTON FWY SUITE 139
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City | BLOOMINGTON
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State | MN
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Zip | 55420-3435
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Country | US
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Telephone | 952-881-6797
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Fax | 952-881-2028
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES RODERICK BLONS
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Credential | PH.D., L.P.
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Telephone | 952-881-6797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4351
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License Number State | MN
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