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1174962617
STACY LYN BLACKWELL
WYOMING, MI
NPI
1174962617
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MI 6801095510)
Enumeration Date
2013-06-18
Last Update Date
2013-06-18
Business Address
-- STACY LYN BLACKWELL LLMSW
961 JOOSTEN ST SW
WYOMING, MI 49509-1449
Phone number: 616-452-8703
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Mailing Address
-- STACY LYN BLACKWELL LLMSW
1939 DIVISION AVE S
GRAND RAPIDS, MI 49507-2459
Phone number: 616-247-3815
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