Provider Demographics
NPI:1649655358
Name:BLOHM, RANIELLE LEA (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANIELLE
Middle Name:LEA
Last Name:BLOHM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RAINELLE
Other - Middle Name:LEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1004 HWY 104
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640
Mailing Address - Country:US
Mailing Address - Phone:209-274-4911
Mailing Address - Fax:
Practice Address - Street 1:821 E ACCIPITER CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2711
Practice Address - Country:US
Practice Address - Phone:949-421-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA32319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist