Provider Demographics
NPI:1134373681
Name:BLOTNER, JENNIFER NANCY (MS SPECIAL ED)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NANCY
Last Name:BLOTNER
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7021
Mailing Address - Country:US
Mailing Address - Phone:845-425-6612
Mailing Address - Fax:
Practice Address - Street 1:25 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5468
Practice Address - Country:US
Practice Address - Phone:888-518-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst