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NPI Code Detail

MEDICARE: JAMIE BLOSSOM MSW, LISW

MEDICARE: JAMIE BLOSSOM MSW, LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerI.2103159OH

General Provider Information

NPI Number : 1558784058
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE BLOSSOM MSW, LISW
Provider Business Mailing Address
First Line : 2202 PRAME AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4747 MONROE ST
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4307
Country : US
Telephone Number : 833-692-9135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2014
Last Update Date : 04/13/2026

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Directions to “ JAMIE BLOSSOM MSW, LISW” Practice Location

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