Provider Demographics
NPI:1093406183
Name:BLACKBURN, KERRI (BS)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0289
Mailing Address - Country:US
Mailing Address - Phone:517-833-8100
Mailing Address - Fax:
Practice Address - Street 1:38271 MOUND RD BLDG B
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3401
Practice Address - Country:US
Practice Address - Phone:586-477-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator