Provider Demographics
NPI:1548842271
Name:BLACKERBY, JOANNE M (NBHWC - HWC)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:BLACKERBY
Suffix:
Gender:F
Credentials:NBHWC - HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 LEDGE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3717
Mailing Address - Country:US
Mailing Address - Phone:512-657-2544
Mailing Address - Fax:
Practice Address - Street 1:6200 LEDGE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3717
Practice Address - Country:US
Practice Address - Phone:512-657-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3139532