Individual
BEVERLY DEMITRA BLUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1725 S NAPERVILLE RD STE 110, WHEATON, IL 60189-5855
(815) 469-1500
Mailing address
2340 FAIROYAL DR, DES PERES, MO 63131-1922
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2017019682
MO
Other
Enumeration date
08/15/2017
Last updated
05/19/2020
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