Basic Information
Provider Information
NPI: 1003000340
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLOWERS
FirstName: TODD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13795 KENWOOD DR
Address2:  
City: BAXTER
State: MN
PostalCode: 564258504
CountryCode: US
TelephoneNumber: 4353130686
FaxNumber:  
Practice Location
Address1: 13795 KENWOOD DR
Address2:  
City: BAXTER
State: MN
PostalCode: 564258504
CountryCode: US
TelephoneNumber: 4353130686
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2007
LastUpdateDate: 08/29/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XASHA01114077MIY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
235Z00000X  N Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
0111407701MIASHA #OTHER


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