Heidi Blaylock, BCBA

NPI #1851574537 in O Fallon, Missouri

Provider Information

NPI Number: 1851574537
Entity Type: Individual
Name: Heidi Blaylock, BCBA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: BCBA
Enumeration Date: Dec 17, 2007
Last Updated: Dec 17, 2007

Practice Location

Address: 321 COPPER TREE CT
City: O Fallon
State: Missouri
ZIP Code: 63368-6339
Phone: (636) 265-0407

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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