Provider Demographics
NPI:1013344159
Name:BLOHM, CYNTHIA DALE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DALE
Last Name:BLOHM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DALE
Other - Last Name:DORNBLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-982-0528
Mailing Address - Fax:501-533-6326
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-982-0528
Practice Address - Fax:501-533-6326
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist