Provider Demographics
NPI:1629591706
Name:BLOMMER, MEGAN BRIDGET (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BRIDGET
Last Name:BLOMMER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SELBY AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1884
Mailing Address - Country:US
Mailing Address - Phone:651-383-2345
Mailing Address - Fax:
Practice Address - Street 1:370 SELBY AVE STE 303
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1884
Practice Address - Country:US
Practice Address - Phone:651-383-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist