Provider Demographics
NPI:1346635257
Name:BLACKWELL, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BLACKWELL
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 1:1021 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-286-0759
Mailing Address - Fax:919-286-4676
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:SUITE E
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4400
Practice Address - Country:US
Practice Address - Phone:919-466-9900
Practice Address - Fax:919-462-9193
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC837A01237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist