Individual
BLAKE HUDSPETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 COLLEGE RD, LEBANON, IL 62254-1291
(618) 537-6929
Mailing address
701 COLLEGE RD, LEBANON, IL 62254-1291
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004108
IL
Other
Enumeration date
06/25/2020
Last updated
06/25/2020
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