| Doctor Name: | DR. JASON SCOTT BLUEMLEIN |
| NPI Number: | 1124162334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D. |
| License Number: | 0772 |
| Business Practice Address: | 2106 Chamber Center Dr Lakeside Park, KY - 410171669 |
| Business Phone Number: | 8594264673 |
| Business Fax Number: | 8594265175 |
| Mailing Address: | 2106 Chamber Center Dr, LAKESIDE PARK |
| State: | KY |
| Postal Code: | 410171669 |
| Phone Number: | 8594264673 |
| Fax Number: | 8594265175 |
| NPI Enumeration Date: | 02/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0772 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |