Individual
MRS. BONNIE ANN BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1200 N WEST AVE, 600, JACKSON, MI 49202-2179
(517) 780-3304
Mailing address
1200 NORTH WEST AVENUE, 600, JACKSON, MI 49202
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801088175
MI
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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