Individual
HEATHER BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8512 W HERSHEY RD, PEARL CITY, IL 61062-9571
(815) 275-8134
Mailing address
8512 W HERSHEY RD, PEARL CITY, IL 61062-9571
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-46456
IL
Other
Enumeration date
05/19/2018
Last updated
05/19/2018
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