Provider Demographics
NPI:1740012491
Name:LENTZ, BLOSSOM CORINNE (CF-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:BLOSSOM
Middle Name:CORINNE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:CF-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RIDER AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3922
Mailing Address - Country:US
Mailing Address - Phone:631-513-2659
Mailing Address - Fax:
Practice Address - Street 1:245 RIDER AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3922
Practice Address - Country:US
Practice Address - Phone:631-513-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist