Healthcare Provider Details

I. General information

NPI: 1083424329
Provider Name (Legal Business Name): DABNEY BLACKWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13900 HULL STREET RD
MIDLOTHIAN VA
23112-2004
US

IV. Provider business mailing address

13900 HULL STREET RD
MIDLOTHIAN VA
23112-2004
US

V. Phone/Fax

Practice location:
  • Phone: 804-639-8788
  • Fax:
Mailing address:
  • Phone: 804-639-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011701
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: