Provider Demographics
NPI:1982478533
Name:BLACKSTONE, JEANETTE (JANN) ADRIANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE (JANN)
Middle Name:ADRIANNE
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 E WHITE ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4913
Mailing Address - Country:US
Mailing Address - Phone:480-522-4449
Mailing Address - Fax:
Practice Address - Street 1:4739 E WHITE ASTER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4913
Practice Address - Country:US
Practice Address - Phone:480-522-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach