Provider Demographics
NPI:1295028421
Name:VANDERBLOEMEN, CAROLYN LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LYNN
Last Name:VANDERBLOEMEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:L
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1401 FIRLAND DR
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6623
Mailing Address - Country:US
Mailing Address - Phone:503-298-9808
Mailing Address - Fax:
Practice Address - Street 1:407 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3770
Practice Address - Country:US
Practice Address - Phone:253-697-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical