Individual
JACQUELINE BLAKEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 N GARDEN AVE, SIERRA VISTA, AZ 85635-3805
(520) 732-0871
Mailing address
75 N GARDEN AVE, SIERRA VISTA, AZ 85635-3805
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0003205
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003205
PEER SUPPORT SPECIALIST
AZ
Enumeration date
01/17/2015
Last updated
03/05/2015
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