Provider Demographics
NPI:1316176886
Name:BLOOD, MAIJA LISA
Entity type:Individual
Prefix:MRS
First Name:MAIJA
Middle Name:LISA
Last Name:BLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAIJA
Other - Middle Name:LISA
Other - Last Name:HUSAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4026
Practice Address - Country:US
Practice Address - Phone:936-671-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist