Provider Demographics
NPI:1073184156
Name:TREFZGER-BLESSENT, TARA SUMMER (MHP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:SUMMER
Last Name:TREFZGER-BLESSENT
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAGOUN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4741
Mailing Address - Country:US
Mailing Address - Phone:309-830-8097
Mailing Address - Fax:
Practice Address - Street 1:101 MAGOUN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4741
Practice Address - Country:US
Practice Address - Phone:309-830-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker