Provider Demographics
NPI:1932433943
Name:BLUEMEL, CHARLYN
Entity Type:Individual
Prefix:
First Name:CHARLYN
Middle Name:
Last Name:BLUEMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MT. VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-0908
Mailing Address - Country:US
Mailing Address - Phone:307-786-4556
Mailing Address - Fax:
Practice Address - Street 1:1500 MT. VIEW DR.
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937-0908
Practice Address - Country:US
Practice Address - Phone:307-786-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services