Individual
CLYDIE BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
505 S 8TH ST, EAST SAINT LOUIS, IL 62201-2919
(618) 474-7330
Mailing address
329 N 81ST ST, CAHOKIA HEIGHTS, IL 62203-2509
(770) 896-0187
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
041165940
IL
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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