Provider Demographics
NPI:1295224020
Name:BLAUW, JON (PHDNE)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:BLAUW
Suffix:
Gender:M
Credentials:PHDNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KIMBARK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5585
Mailing Address - Country:US
Mailing Address - Phone:303-651-1515
Mailing Address - Fax:720-652-0408
Practice Address - Street 1:500 KIMBARK ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5585
Practice Address - Country:US
Practice Address - Phone:303-651-1515
Practice Address - Fax:720-652-0408
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical