Basic Information
| Provider Information | |||||||||
| NPI: | 1265671135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLODGETT | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 MIDDLE ST | ||||||||
| Address2: | SUITE 1201 | ||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327463625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666100580 | ||||||||
| FaxNumber: | 8666100580 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 PALM COAST PKWY SW | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321374739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869513044 | ||||||||
| FaxNumber: | 8666100580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2009 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.