Individual
DR. JOAN BLACKWOOD DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HSPP
Contact information
Practice address
3008 BEVCHER DR, MADISON, IN 47250-3863
(812) 265-1918
(812) 265-1828
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
(812) 337-2438
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20041196A
IN
103TC0700X
Clinical Psychologist
Primary
20041196A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209017
ANTHEM PIN
IN
05
—
200172180A
—
IN
Enumeration date
02/02/2006
Last updated
05/06/2014
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