Provider Demographics
NPI:1114466323
Name:BLAHA, JONALYN (PSYD)
Entity Type:Individual
Prefix:
First Name:JONALYN
Middle Name:
Last Name:BLAHA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 N WILLIAMS ST STE 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2661
Mailing Address - Country:US
Mailing Address - Phone:720-507-6923
Mailing Address - Fax:
Practice Address - Street 1:1290 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2600
Practice Address - Country:US
Practice Address - Phone:720-507-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0107232174400000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist