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NPI Code Detail

MEDICARE: MRS. DE-ANDREA BLAYLOCK-SOLAR MSW, LCSW, CST

MEDICARE: MRS. DE-ANDREA BLAYLOCK-SOLAR MSW, LCSW, CST
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 Worker2010006307MO

General Provider Information

NPI Number : 1861718520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DE-ANDREA BLAYLOCK-SOLAR MSW, LCSW, CST
Provider Business Mailing Address
First Line : 9666 OLIVE BLVD STE 330
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3035
Country : US
Telephone Number : 314-877-8510
Fax Number :
Provider Business Practice Location Address
First Line : 9666 OLIVE BLVD STE 330
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3035
Country : US
Telephone Number : 314-877-8510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2010
Last Update Date : 05/09/2023

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Directions to “ MRS. DE-ANDREA BLAYLOCK-SOLAR MSW, LCSW, CST” Practice Location

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