Provider Demographics
NPI:1952186397
Name:BLOMQUIST, ELIZABETH MARIE (BSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:BLOMQUIST
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:BLOMQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3335 BROOKSHEAR CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2213
Mailing Address - Country:US
Mailing Address - Phone:231-534-1434
Mailing Address - Fax:
Practice Address - Street 1:1010 E WEST MAPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3571
Practice Address - Country:US
Practice Address - Phone:248-313-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator