Provider Demographics
NPI:1700277787
Name:BLOSSER, JEFFREY (MA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BLOSSER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 1/2 S. 5TH STREET
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528
Mailing Address - Country:US
Mailing Address - Phone:574-329-3984
Mailing Address - Fax:
Practice Address - Street 1:2426 E PIERCETON RD
Practice Address - Street 2:
Practice Address - City:WINONA LAKE
Practice Address - State:IN
Practice Address - Zip Code:46590-5713
Practice Address - Country:US
Practice Address - Phone:574-269-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor