Donna L Blache, LCSW
Individual provider Active NPI Clinical Social Worker · Murphysboro, IL
NPI 1992713416 · NPPES record last updated Apr 4, 2011
Key facts
- NPI
- 1992713416
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149010444 (IL)
- Practice address
- 7 S Hospital Dr
Murphysboro, IL 62966-3333 - Phone
- (618) 687-3418
- Fax
- (618) 687-1859
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149010444 | IL | Yes |
Addresses
Primary practice location
7 S Hospital Dr
Murphysboro, IL 62966-3333
Mailing address
P O Box 577
Carterville, IL 62918-0577
Phone (618) 985-8221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370966854002 | Medicaid | IL | |
| 370966854005 | Medicaid | IL | |
| 640701 | Other | IL | PTAN MEDICARE |
Other names
- Donna L Knowlton
Other providers in Murphysboro, IL
- Jonathan Robert Ashton
- Lisa Christine Baranski
- Julia Bates
- Evan Tep Belfer
- Frederick Gower Bierer
- Dale W Blaise
- Melinda Luanne Bloos
- Richard Earl Boren
- Andrea Deneen Brewer
- Zeppelyn Dawn Brewer
All providers in Murphysboro, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.