Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.007330 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.007330 | IL |
NPI | 1003092008 |
---|---|
Provider Name | Dr. Christina Joy Blodgett |
First Address | Algonquin, IL 60102-5917 |
Second Address | Algonquin, IL 60102-5917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K51467 | (02) | IL |