Provider Demographics
NPI:1629582838
Name:BLACKWELL, DANIELLE CLAIRE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CLAIRE
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 1:540 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1571
Mailing Address - Country:US
Mailing Address - Phone:504-906-1703
Mailing Address - Fax:
Practice Address - Street 1:540 TUCKER AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1571
Practice Address - Country:US
Practice Address - Phone:504-906-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer