Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1124501390 |
---|---|
Provider Name | Thomas Anthony Blass |
First Address | Saint Paul, MN 55103-1719 |
Second Address | Saint Paul, MN 55103-1719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |