Provider Demographics
NPI:1396805016
Name:BLACKINTON, JOSEPH G (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:BLACKINTON
Suffix:
Gender:M
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:HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - Street 2:904 W 23RD ST STE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:HEARTLAND PSYCHOLOGICAL SERVICES
Practice Address - Street 2:904 W 23RD ST STE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
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9171289OtherDAKOTA CARE
SD0007252OtherBLUE CROSS
SD6550552Medicaid
9171289OtherDAKOTA CARE