Provider Demographics
NPI:1629807292
Name:BLOUNT, JOANNE MARIE (PPS, LEP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:PPS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17706 E BENTLEY CT
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:CA
Mailing Address - Zip Code:95236-9647
Mailing Address - Country:US
Mailing Address - Phone:209-401-5275
Mailing Address - Fax:
Practice Address - Street 1:9550 RONALD E MCNAIR WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-2800
Practice Address - Country:US
Practice Address - Phone:209-953-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4204103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool