Individual
MRS. SUSAN KLINT BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1220 E 2ND AVE, MONMOUTH, IL 61462-2404
(309) 734-7902
(309) 734-7114
Mailing address
2261 US HIGHWAY 67, MONMOUTH, IL 61462-9694
(309) 734-7902
(309) 734-7114
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
SB22990398P
IL
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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