Individual
DONNA L BLACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 687-3418
(618) 687-1859
Mailing address
P O BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149010444
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370966854002
—
IL
05
—
370966854005
—
IL
01
—
640701
PTAN MEDICARE
IL
Enumeration date
08/03/2006
Last updated
04/04/2011
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