Carolyn Rae Blackdeer, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9774-123 Issued in WI

Practice address

500 E Veterans St
Tomah, WI 54660-3105

Phone

(608) 372-3971

NPI assigned

Sep 8, 2021

Last updated

Sep 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1013686658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27824 EPIC AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546604505",
            "telephone_number": "612-221-9364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E VETERANS ST",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546603105",
            "telephone_number": "608-372-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKDEER",
        "first_name": "CAROLYN",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9774-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "carolyn.blackdeer@va.gov",
            "affiliation": "N",
            "address_1": "500 E Veterans St",
            "city": "Tomah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546603105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Harlan Bergum, NBCHWC
• John Frederick Berry, M.D.
• Laura Edie Betthauser, RN
• Leanne V Beyer, RN
• Sarah Black, RN
• Elliot Blackdeer
• Blado Dental Clinic LTD.
• Esta Amanda Blevins, MSW, LCSW
• Jill E Boulden, MD
• Thomas E Boulden, OD

• Clinical Social Worker in Tomah, WI
• Providers in Tomah, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.