Provider Demographics
NPI:1861490690
Name:BLONIGEN, JULIA ANNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANNA
Last Name:BLONIGEN
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 1:1882 KILIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304
Mailing Address - Country:US
Mailing Address - Phone:320-251-4038
Mailing Address - Fax:320-251-4038
Practice Address - Street 1:1882 KILIAN BLVD
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304
Practice Address - Country:US
Practice Address - Phone:320-251-4038
Practice Address - Fax:320-251-4038
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist