| Doctor Name: | SHARI BLACKBURN |
| NPI Number: | 1174850002 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AF740302832 |
| Business Practice Address: | 3399 Oxbow Dr Fort Gratiot, MI - 480594124 |
| Business Phone Number: | 8109908134 |
| Business Fax Number: | |
| Mailing Address: | 3399 Oxbow Dr, FORT GRATIOT |
| State: | MI |
| Postal Code: | 480594124 |
| Phone Number: | 8109908134 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2009 |
| NPI Last Update Date: | 11/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320600000X |
| License Number: | AF740302832 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |