Provider Demographics
NPI:1851594980
Name:BLOMBERG, DAWN S (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:S
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18613 201ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-5947
Mailing Address - Country:US
Mailing Address - Phone:206-963-6252
Mailing Address - Fax:425-788-4782
Practice Address - Street 1:18613 201ST AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-5947
Practice Address - Country:US
Practice Address - Phone:206-963-6252
Practice Address - Fax:425-788-4782
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist