Individual
DERRICK BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
909 CUSHMAN ST STE 103, FAIRBANKS, AK 99701-4668
(907) 456-4620
Mailing address
909 CUSHMAN ST STE 103, FAIRBANKS, AK 99701-4668
(907) 456-4620
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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