Individual
DR. CHARLES RODERICK BLONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., L.P.
Contact information
Practice address
9001 E BLOOMINGTON FWY, SUITE 139, BLOOMINGTON, MN 55420-3435
(952) 881-6797
(952) 881-2028
Mailing address
9001 E BLOOMINGTON FWY, SUITE 139, BLOOMINGTON, MN 55420-3435
(952) 881-6797
(952) 881-2028
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4351
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
295L6BL
BLUE CROSS BLUE SHIELD
MN
01
—
30247-02
PREFERRED ONE
MN
05
—
430048300
—
MN
Enumeration date
04/14/2006
Last updated
07/02/2010
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