Provider Demographics
NPI:1649725219
Name:BLASING, JOYLYNN LEANNE
Entity type:Individual
Prefix:
First Name:JOYLYNN
Middle Name:LEANNE
Last Name:BLASING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:LEANNE
Other - Last Name:BLASING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 N ALMA CT
Mailing Address - Street 2:P.O. BOX 505
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-8081
Mailing Address - Country:US
Mailing Address - Phone:309-712-2529
Mailing Address - Fax:
Practice Address - Street 1:2065 HALF DAY ROAD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-1241
Practice Address - Country:US
Practice Address - Phone:847-945-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB425432947412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer