Individual
SHARI BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3399 OXBOW DR, FORT GRATIOT, MI 48059-4124
(810) 990-8134
Mailing address
3399 OXBOW DR, FORT GRATIOT, MI 48059-4124
(810) 990-8134
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AF740302832
MI
Other
Enumeration date
11/13/2009
Last updated
11/13/2009
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