Provider Demographics
NPI:1770017923
Name:BLAZING, STEVEN MARK JR (BS, LSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:BLAZING
Suffix:JR
Gender:M
Credentials:BS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3716
Mailing Address - Country:US
Mailing Address - Phone:507-519-0755
Mailing Address - Fax:651-289-9900
Practice Address - Street 1:2055 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-3716
Practice Address - Country:US
Practice Address - Phone:651-289-1202
Practice Address - Fax:651-289-9900
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker