=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598534422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ARDELLE BLINN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 12/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9160 MARSHALL RD
-----------------------------------------------------
City | CRANBERRY TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-553-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 FREW RD
-----------------------------------------------------
City | ELLWOOD CITY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16117-7622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-498-6796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF001242
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------