Provider Demographics
NPI:1326090317
Name:CHARLES BLONS, PLLC
Entity Type:Organization
Organization Name:CHARLES BLONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RODERICK
Authorized Official - Last Name:BLONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:952-881-6797
Mailing Address - Street 1:9001 E BLOOMINGTON FWY
Mailing Address - Street 2:SUITE 139
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3435
Mailing Address - Country:US
Mailing Address - Phone:952-881-6797
Mailing Address - Fax:952-881-2028
Practice Address - Street 1:9001 E BLOOMINGTON FWY
Practice Address - Street 2:SUITE 139
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3435
Practice Address - Country:US
Practice Address - Phone:952-881-6797
Practice Address - Fax:952-881-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN295L6BLOtherBLUE CROSS BLUE SHIELD
MN30247-02OtherPREFERRED ONE
MN430048300Medicaid
MN680001898Medicare ID - Type Unspecified