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NPI Code Detail

MEDICARE: MISS SARA RUTH BLACKLIDGE PC

MEDICARE: MISS SARA RUTH BLACKLIDGE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorC.1200338OH

General Provider Information

NPI Number : 1740622976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SARA RUTH BLACKLIDGE PC
Provider Business Mailing Address
First Line : 261 REGENCY RIDGE DR
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4221
Country : US
Telephone Number : 937-410-3233
Fax Number :
Provider Business Practice Location Address
First Line : 261 REGENCY RIDGE DR
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4221
Country : US
Telephone Number : 937-410-3233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2013
Last Update Date : 12/10/2024

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