Provider Demographics
NPI:1710109038
Name:BLACKDEER, LINDA M (CAP, BSW)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:M
Last Name:BLACKDEER
Suffix:
Gender:F
Credentials:CAP, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 N CENTER ST STE 103
Mailing Address - Street 2:3900 E 12TH ST # 416
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1926
Mailing Address - Country:US
Mailing Address - Phone:307-235-2000
Mailing Address - Fax:307-235-2015
Practice Address - Street 1:254 N CENTER ST STE 103
Practice Address - Street 2:3900 E 12TH ST # 416
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1926
Practice Address - Country:US
Practice Address - Phone:307-235-2000
Practice Address - Fax:307-235-2015
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)