Provider Demographics
NPI:1740494616
Name:BLAZER, BONITA (PHD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:
Last Name:BLAZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N WASHINGTON AVE
Mailing Address - Street 2:STE 202 - EAST BUILDING
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2448
Mailing Address - Country:US
Mailing Address - Phone:856-234-1270
Mailing Address - Fax:856-234-0632
Practice Address - Street 1:302 N WASHINGTON AVE
Practice Address - Street 2:STE 202 - EAST BUILDING
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2448
Practice Address - Country:US
Practice Address - Phone:856-234-1270
Practice Address - Fax:856-234-0632
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist