MEDICARE: APRIL BLUCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1902272446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL BLUCK

Provider Business Mailing Address
First Line	:	PO BOX 674779
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-4779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 MUNSON AVE
Second Line	:	STE 103
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3059
Country	:	US
Telephone Number	:	800-968-6866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ APRIL BLUCK ” Practice Location

Language	Start Address	Practice Location

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