Provider Demographics
NPI:1740622976
Name:BLACKLIDGE, SARA RUTH (PC)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:RUTH
Last Name:BLACKLIDGE
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 REGENCY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4221
Mailing Address - Country:US
Mailing Address - Phone:937-410-3233
Mailing Address - Fax:
Practice Address - Street 1:261 REGENCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4221
Practice Address - Country:US
Practice Address - Phone:937-410-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional