| Doctor Name: | GWENDA LYNN BLUM |
| NPI Number: | 1770792335 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 620 13th St Apt A Imperial Beach, CA - 919321722 |
| Business Phone Number: | 6196284869 |
| Business Fax Number: | |
| Mailing Address: | 620 13th St Apt A, IMPERIAL BEACH |
| State: | CA |
| Postal Code: | 919321722 |
| Phone Number: | 6196284869 |
| Fax Number: | |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |