Provider Demographics
NPI:1225342355
Name:BLOXHAM, ABBY JOAN (LMSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:JOAN
Last Name:BLOXHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2433
Mailing Address - Country:US
Mailing Address - Phone:316-425-0073
Mailing Address - Fax:
Practice Address - Street 1:2821 BROOKSIDE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2433
Practice Address - Country:US
Practice Address - Phone:316-425-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker