Individual
LINDSAY MARIE BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
463 WOOSTER AVE APT D23, SAN JOSE, CA 95116-1096
(408) 712-0825
Mailing address
463 WOOSTER AVE APT D23, SAN JOSE, CA 95116-1096
(408) 712-0825
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2007
Last updated
09/27/2007
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