Provider Demographics
NPI:1497736086
Name:BLASZAK, BARBARA J (MA , BSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:BLASZAK
Suffix:
Gender:F
Credentials:MA , BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6022
Mailing Address - Country:US
Mailing Address - Phone:541-773-4074
Mailing Address - Fax:541-201-0803
Practice Address - Street 1:107 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-6048
Practice Address - Country:US
Practice Address - Phone:541-773-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC 0083 MFT 0038101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor