Provider Demographics
NPI:1861758617
Name:BLOMQUIST, TORI ANN (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:TORI
Middle Name:ANN
Last Name:BLOMQUIST
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MISS
Other - First Name:TORI
Other - Middle Name:ANN
Other - Last Name:GREEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:3857 WOLVERINE ST NE # 16C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-4270
Mailing Address - Country:US
Mailing Address - Phone:503-588-1039
Mailing Address - Fax:503-588-1468
Practice Address - Street 1:3857 WOLVERINE ST NE # 16C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4270
Practice Address - Country:US
Practice Address - Phone:503-588-1039
Practice Address - Fax:503-588-1468
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21155231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist