Doctor Name: | MRS. JOLENE BLACKLANCE |
NPI Number: | 1033173349 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW LCSW |
License Number: | 1265 |
Business Practice Address: | 3200 Canyon Lake Dr Rapid City, SD - 577028114 |
Business Phone Number: | 6053552215 |
Business Fax Number: | 6053552504 |
Mailing Address: | 3200 Canyon Lake Dr, RAPID CITY |
State: | SD |
Postal Code: | 577028114 |
Phone Number: | 6053552215 |
Fax Number: | 6053552504 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 1265 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |