Individual
ALEXANDER BLAKE MARTINCIC DURBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
2615 EDWARDS ST, ALTON, IL 62002-3915
(618) 462-2331
(618) 462-2504
Mailing address
902 W MAIN ST, WEST FRANKFORT, IL 62896-2210
(618) 937-6483
(618) 937-1440
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/23/2024
Last updated
11/04/2024
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