Provider Demographics
NPI:1407193048
Name:BLACKWELDER, DANA FRANCIS (AA, BS, MS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:FRANCIS
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:AA, BS, MS
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 REESE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-8604
Mailing Address - Country:US
Mailing Address - Phone:406-438-3083
Mailing Address - Fax:
Practice Address - Street 1:5202 REESE HILL RD
Practice Address - Street 2:
Practice Address - City:SUMAS
Practice Address - State:WA
Practice Address - Zip Code:98295-8604
Practice Address - Country:US
Practice Address - Phone:406-438-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB60829685106E00000X
WABA61045045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst