| Doctor Name: | NIKKI BLOMQUIST |
| NPI Number: | 1053476408 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 05-11-105 |
| Business Practice Address: | 524 Main St Oregon City, OR - 970451824 |
| Business Phone Number: | 5036558558 |
| Business Fax Number: | 5036558197 |
| Mailing Address: | 524 Main St, OREGON CITY |
| State: | OR |
| Postal Code: | 970451824 |
| Phone Number: | 5036558558 |
| Fax Number: | 5036558197 |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 05-11-105 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |