Provider Demographics
NPI:1417832544
Name:BLACKMON, ELIZABETH (LSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16005 BRIARGATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1330
Mailing Address - Country:US
Mailing Address - Phone:219-671-9843
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 30
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7651
Practice Address - Country:US
Practice Address - Phone:219-671-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150115139104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker