BARBARA AUTREY H BLAYLOCK Clinical Psychologist License verification

Business Entity

CANCELLED

License Type

Clinical Psychologist

Description

REGISTERED PSYCHOLOGIST

License Number

072002302

License Status

CANCELLED

Business

First Name

BARBARA AUTREY H

Last Name

BLAYLOCK

Business Name

BARBARA AUTREY H BLAYLOCK

Original Issue Date

05/22/1978

Expiration Date

09/30/1990

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/04/2005