Provider Demographics
NPI:1770721326
Name:BLACKBURN, ALLISON (PHD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:BARNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 4002
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-9645
Mailing Address - Fax:513-636-3800
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 4002
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-9645
Practice Address - Fax:513-636-3800
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
KY0937103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7495OtherOHIO LICENSE