Provider Demographics
NPI:1114642717
Name:BLACKWELL-ELLIOTT, J'RIE (TCM)
Entity Type:Individual
Prefix:
First Name:J'RIE
Middle Name:
Last Name:BLACKWELL-ELLIOTT
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 LOWER CANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-9761
Mailing Address - Country:US
Mailing Address - Phone:859-309-1771
Mailing Address - Fax:
Practice Address - Street 1:1995 LOWER CANE CREEK RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-9761
Practice Address - Country:US
Practice Address - Phone:859-309-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator