Individual
MS. SHERRY G BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
208 SWEETWATER RIM, PINEVILLE, LA 71360-5691
(318) 419-8176
Mailing address
4126 MARYLAND AVE, SHREVEPORT, LA 71106-1438
(318) 470-7600
(318) 868-2468
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LA 2617
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4600442
MEDAVANT
LA
Enumeration date
09/15/2009
Last updated
09/15/2009
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