Provider Demographics
NPI:1730937079
Name:BLACKNEY, LEA (MT-BC)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:BLACKNEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:MATTHYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-0986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 E. 5TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:262-682-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist