Provider Demographics
NPI:1912288580
Name:BLONQUIST, VICTORIA RUTH
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:RUTH
Last Name:BLONQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 N 80 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2198
Mailing Address - Country:US
Mailing Address - Phone:630-441-2750
Mailing Address - Fax:
Practice Address - Street 1:1774 N 80 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2198
Practice Address - Country:US
Practice Address - Phone:630-441-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator