Individual
SUSAN BLAKSTONE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
345 DOUCET RD, LAFAYETTE, LA 70503-3407
(337) 989-2084
Mailing address
PO BOX 1254, BROUSSARD, LA 70518-1254
(337) 837-9837
(337) 837-3616
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2215
LA
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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