Individual
ALISHA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
Mailing address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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