Provider Demographics
NPI:1215112032
Name:BLAZI, SHERRY A (MSW)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:A
Last Name:BLAZI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:A
Other - Last Name:PLEMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, ACSW, IMH-EIII
Mailing Address - Street 1:401 E OAK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8626
Mailing Address - Country:US
Mailing Address - Phone:405-623-1596
Mailing Address - Fax:
Practice Address - Street 1:401 E OAK CLIFF DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8626
Practice Address - Country:US
Practice Address - Phone:405-623-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical