Individual
BLAKE RUSSWINKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
2014 VANDALIA ST, COLLINSVILLE, IL 62234-4848
(618) 345-9536
Mailing address
1651 CHEROKEE RD APT 3B, LAKE OZARK, MO 65049-4955
(217) 473-9889
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150104739
IL
Other
Enumeration date
03/16/2022
Last updated
04/27/2022
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