Provider Demographics
NPI:1245242536
Name:BLY, SONIA JO (MS, DC)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:JO
Last Name:BLY
Suffix:
Gender:F
Credentials:MS, DC
Other - Prefix:MISS
Other - First Name:SONIA
Other - Middle Name:JO
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:205 PRAIRIEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-5486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2010
Practice Address - Country:US
Practice Address - Phone:507-532-3236
Practice Address - Fax:507-532-0240
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN613K4BLOtherBLUE CROSS BLUE SHIELD
MN49412OtherSIOUX VALLEY HEALTH
MN988631045917OtherPREFERRED ONE
MNHP58525OtherHEALTH PARTNERS