Provider Demographics
NPI:1003702556
Name:BLUM, JENNA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:NICOLE
Last Name:BLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1400
Mailing Address - Country:US
Mailing Address - Phone:215-840-8096
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 900
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3727
Practice Address - Country:US
Practice Address - Phone:215-840-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical