Provider Demographics
NPI:1053509026
Name:BLASINGAME, HEATHER (BS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:BLASINGAME
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:504 MICAH DRIVE
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-0913
Mailing Address - Country:US
Mailing Address - Phone:618-395-4306
Mailing Address - Fax:618-395-4507
Practice Address - Street 1:1501 OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2269
Practice Address - Country:US
Practice Address - Phone:618-943-3451
Practice Address - Fax:618-943-4368
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health