Individual
SUSAN W BLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
6651 CHIPPEWA, STE 223, ST LOUIS, MO 63109-2531
(314) 644-2395
(314) 644-5917
Mailing address
6651 CHIPPEWA, STE 223, ST LOUIS, MO 63109-2531
(314) 644-2395
(314) 644-5917
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3894
BLUE CROSS
—
01
—
6156413
BLUE CROSS HARMONY
—
01
—
S21684
MARCY HMO
—
Enumeration date
07/25/2006
Last updated
07/08/2007
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