Provider Demographics
NPI:1194033167
Name:BLUM, TAMARA ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ELIZABETH
Last Name:BLUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:YANUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TAMARA YANUCK
Mailing Address - Street 1:7751 CARONDELET AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3340
Mailing Address - Country:US
Mailing Address - Phone:314-718-6448
Mailing Address - Fax:
Practice Address - Street 1:7751 CARONDELET AVE STE 203
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3340
Practice Address - Country:US
Practice Address - Phone:314-718-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010010928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker