Provider Demographics
NPI:1245010693
Name:BLOMBERG, KAREN (SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6136
Mailing Address - Country:US
Mailing Address - Phone:317-430-3018
Mailing Address - Fax:317-884-3388
Practice Address - Street 1:1 FREDERICK HEALTH WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-9435
Practice Address - Country:US
Practice Address - Phone:240-566-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist