| Doctor Name: | DR. RICHARD ANTHONY BLACKBURN |
| NPI Number: | 1134293400 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | LP 4743 |
| Business Practice Address: | 1400 N Union Ave Fergus Falls, MN - 565371248 |
| Business Phone Number: | 2187397394 |
| Business Fax Number: | 2187397268 |
| Mailing Address: | 54666 Us Highway 10, NEW YORK MILLS |
| State: | MN |
| Postal Code: | 565679000 |
| Phone Number: | 2183852203 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP 4743 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |