Individual
MRS. JOAN BANOVETZ BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2800 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3232
(612) 331-4429
Mailing address
313 MADISON AVE S, EDINA, MN 55343
(952) 931-9885
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17053
MN
Other
Enumeration date
08/13/2009
Last updated
08/13/2009
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