Individual
JENNIFER KING BLACKLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
209 TRAVIS ST, STE 105, ROANOKE, TX 76262-8661
(817) 988-9121
Mailing address
209 TRAVIS ST, STE 105, ROANOKE, TX 76262-8661
(817) 988-9121
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33692
TX
Other
Enumeration date
01/08/2009
Last updated
03/07/2014
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