Doctor Name: | ALAN J BLOMQUIST |
NPI Number: | 1750448627 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 149005073 |
Business Practice Address: | 1015 Oconor Ave La Salle, IL - 613011216 |
Business Phone Number: | 8152230303 |
Business Fax Number: | 8152235815 |
Mailing Address: | 1015 O Conor Ave, Bldg M LASALLE |
State: | IL |
Postal Code: | 61301 |
Phone Number: | 2172229487 |
Fax Number: | 2172228578 |
NPI Enumeration Date: | 01/02/2007 |
NPI Last Update Date: | 08/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149005073 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |