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NPI Code Detail

MEDICARE: LORI BLATTNER

MEDICARE: LORI BLATTNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2009030612MO

General Provider Information

NPI Number : 1730485921
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI BLATTNER
Provider Business Mailing Address
First Line : 112 S BROADVIEW ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-5759
Country : US
Telephone Number : 573-334-3486
Fax Number :
Provider Business Practice Location Address
First Line : 112 S BROADVIEW ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-5759
Country : US
Telephone Number : 573-334-3486
Fax Number : 573-334-3524
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2011
Last Update Date : 10/04/2022

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Directions to “ LORI BLATTNER ” Practice Location

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