Individual
MRS. TIFFANY BLASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1201 RICKER RD, SALEM, IL 62881-4263
(618) 548-3194
Mailing address
16870 NORTH HARMONY LANE, MT VERNON, IL 62864
(618) 978-8456
(618) 548-4902
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
IL
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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