Individual
LARRY VAUGHN BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.I.C.S.W.
Contact information
Practice address
2970 JUDICIAL ROAD, SUITE 100, BURNSVILLE, MN 55337
(952) 224-8990
(952) 224-8991
Mailing address
2970 JUDICIAL ROAD, SUITE 100, BURNSVILLE, MN 55337
(952) 224-8990
(952) 224-8991
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10727
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
708390400
—
MN
Enumeration date
02/17/2010
Last updated
09/25/2024
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