Individual
HEIDI BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
321 COPPER TREE CT, O FALLON, MO 63368-6339
(636) 265-0407
(636) 265-0407
Mailing address
321 COPPER TREE CT, O FALLON, MO 63368-6339
(636) 265-0407
(636) 265-0407
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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