Provider Demographics
NPI:1962182345
Name:BLACKMORE, SYDONEY (CSWA, CPH)
Entity type:Individual
Prefix:MS
First Name:SYDONEY
Middle Name:
Last Name:BLACKMORE
Suffix:
Gender:F
Credentials:CSWA, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-0995
Mailing Address - Country:US
Mailing Address - Phone:503-397-4651
Mailing Address - Fax:
Practice Address - Street 1:2370 GABLE RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2913
Practice Address - Country:US
Practice Address - Phone:503-397-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X, 1041C0700X
OR186242083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine