Provider Demographics
NPI:1861903015
Name:BLAZIER, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:BLAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 AIRLINE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2042
Mailing Address - Country:US
Mailing Address - Phone:318-588-5012
Mailing Address - Fax:
Practice Address - Street 1:4000 AIRLINE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2042
Practice Address - Country:US
Practice Address - Phone:318-588-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker