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Individual

JOI'BETH BLACKWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8824 EVERETT ST, KANSAS CITY, MO 64138-4438
(816) 767-8968
Mailing address
8824 EVERETT ST, KANSAS CITY, MO 64138-4438
(816) 767-8968

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5986-7780
MO
Enumeration date
03/26/2007
Last updated
07/08/2007
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