Provider Demographics
NPI:1487220943
Name:BLAIR-DICK, JOAN IRENE (LMSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:IRENE
Last Name:BLAIR-DICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 W LOCUST ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3354
Mailing Address - Country:US
Mailing Address - Phone:563-445-8710
Mailing Address - Fax:563-445-8710
Practice Address - Street 1:2826 W. LOCUST ST.
Practice Address - Street 2:STE 2A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804
Practice Address - Country:US
Practice Address - Phone:563-445-8710
Practice Address - Fax:563-445-8673
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03609104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker