Provider Demographics
NPI:1205000288
Name:BLACKWELDER, JOAN B
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:B
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SUMMERSET DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8010
Mailing Address - Country:US
Mailing Address - Phone:803-932-2351
Mailing Address - Fax:
Practice Address - Street 1:341 SUMMERSET DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8010
Practice Address - Country:US
Practice Address - Phone:803-932-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist