Individual
DR. MILDRED L BLACKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2100 N MAIN ST # 304, CROWN POINT, IN 46307-1877
(574) 546-1900
(574) 546-1999
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040531A
IN
103TC0700X
Clinical Psychologist
20040561A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006038
MPLAN
IN
01
—
000000182274
BCBS
IN
05
—
100339990C
—
IN
01
—
11383545
CAQH
IN
01
—
148297000
MAGELLAN
IN
01
—
226467
MHN
IN
Enumeration date
08/15/2005
Last updated
07/10/2024
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