Provider Demographics
NPI:1639457633
Name:BLODGETT, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10342 GREENBRIAR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159
Mailing Address - Country:US
Mailing Address - Phone:405-759-2516
Mailing Address - Fax:405-759-2578
Practice Address - Street 1:10342 GREENBRIAR PARKWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-759-2516
Practice Address - Fax:405-759-2578
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor