| Doctor Name: | MR. KERRY D BLACKBURN |
| NPI Number: | 1073666012 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICSW |
| License Number: | LW00005759 |
| Business Practice Address: | 929 Sw 152nd St Suite D Burien, WA - 981661843 |
| Business Phone Number: | 2064313171 |
| Business Fax Number: | 2062427330 |
| Mailing Address: | 929 Sw 152nd St, Suite D BURIEN |
| State: | WA |
| Postal Code: | 981661843 |
| Phone Number: | 2064313171 |
| Fax Number: | 2062427330 |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LW00005759 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |