Provider Demographics
NPI:1972652451
Name:BLACKBURN, LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 VERONICA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5817
Mailing Address - Country:US
Mailing Address - Phone:785-838-0040
Mailing Address - Fax:785-838-0042
Practice Address - Street 1:5103 VERONICA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5817
Practice Address - Country:US
Practice Address - Phone:785-838-0040
Practice Address - Fax:785-838-0042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health