Provider Demographics
NPI:1528204708
Name:ST GERMAIN, BLAINE ROBERT (HIS)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:ROBERT
Last Name:ST GERMAIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W HIGHWAY 10
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1707
Mailing Address - Country:US
Mailing Address - Phone:763-757-2759
Mailing Address - Fax:
Practice Address - Street 1:655 WEST, HYW 10
Practice Address - Street 2:SUITE 2
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1707
Practice Address - Country:US
Practice Address - Phone:763-757-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2635237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist