Individual
JEFFREY W BLOMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PC,CDCA
Contact information
Practice address
601 S EDWIN C MOSES BLVD, 4TH FLOOR, NW BLDG, DAYTON, OH 45417-3424
(937) 734-8333
(937) 734-8339
Mailing address
601 S EDWIN C MOSES BLVD, 4TH FLOOR, NW BLDG, DAYTON, OH 45417-3424
(937) 734-8333
(937) 734-8339
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.1100287
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
C.1100287
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.110594
OH
Other
Enumeration date
01/17/2013
Last updated
12/31/2013
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