MEDICARE: SHEILA BLACKBOURN LCSW

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
1	1041C0700X	Clinical Social Worker	15846	AZ
2	1041C0700X	Clinical Social Worker	I05261	NM
3	1041S0200X	School Social Worker	317372	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891776373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA BLACKBOURN LCSW

Provider Business Mailing Address
First Line	:	7794 S GOLDEN BELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-0088
Country	:	US
Telephone Number	:	575-706-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	7794 S GOLDEN BELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-0088
Country	:	US
Telephone Number	:	575-706-6611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/31/2023

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