MARY EVANS BLOSSOM Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149017697

License Status

INACTIVE

Business

First Name

MARY

Middle

EVANS

Last Name

BLOSSOM

Business Name

MARY EVANS BLOSSOM

Original Issue Date

06/18/2015

Effective Date

11/14/2017

Expiration Date

11/30/2019

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

09/04/2019