Provider Demographics
NPI:1316574866
Name:BLASER, JADE MATRACA (MSW, LADC, LGSW)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:MATRACA
Last Name:BLASER
Suffix:
Gender:F
Credentials:MSW, LADC, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23299 IVYWOOD ST NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-8742
Mailing Address - Country:US
Mailing Address - Phone:763-226-9781
Mailing Address - Fax:
Practice Address - Street 1:1230 SCHOOL ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2422
Practice Address - Country:US
Practice Address - Phone:763-241-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303984101YA0400X
MN282951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)