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Contact Information

JACQUELINE C BLACKBURN, LCSW
205 S. DAVENPORT ST
PO BOX 439
METAMORA, IL61548
 Phone: 309-216-8720
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for JACQUELINE C BLACKBURN · (Female)

NPI Number 1194558585
Status Active
Credentials LCSW (Licensed Clinical Social Worker)
Entity Individual
Enumeration date 08/22/2024
Last updated 08/22/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 149.025801
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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