Individual
JUANITA BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
5904 S KEDZIE AVE APT 303, CHICAGO, IL 60629-3216
(312) 342-9118
Mailing address
5904 S KEDZIE AVE APT 303, CHICAGO, IL 60629-3216
(312) 342-9118
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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