Provider Demographics
NPI:1225153968
Name:BLOHM, KATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:BLOHM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BURNT BOAT DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0812
Mailing Address - Country:US
Mailing Address - Phone:701-323-0924
Mailing Address - Fax:701-323-0935
Practice Address - Street 1:1701 BURNT BOAT DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0812
Practice Address - Country:US
Practice Address - Phone:701-323-0924
Practice Address - Fax:701-323-0935
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11176Medicaid
NDBLO19847OtherBCBS OF NORTH DAKOTA
NDBLO19847OtherBCBS OF NORTH DAKOTA
ND11176Medicaid