Teresa Jane Blakely, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3470 Issued in OH

Practice address

275 E Longview Ave
Columbus, OH 43202-1239

Phone

(614) 262-8317

Fax

(614) 262-5609

NPI assigned

May 12, 2006

Last updated

Dec 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jane Theresa Robertson Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1699726828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 E LONGVIEW AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021239",
            "telephone_number": "614-262-8317",
            "fax_number": "614-262-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 E LONGVIEW AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021239",
            "telephone_number": "614-262-8317",
            "fax_number": "614-262-5609"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5190 Blazer Pkwy",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "OH",
            "postal_code": "430171339",
            "country_code": "US",
            "telephone_number": "614-316-7634",
            "fax_number": "614-262-5609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "TERESA",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "3470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PROVIDER ID",
            "identifier": "401660",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANE",
            "last_name": "ROBERTSON",
            "middle_name": "THERESA",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Elizabeth Blake, MD
• Shanterica Blake
• Tessa Marie Blake
• Andrea M. Blakely, STNA
• Jada Blakely, LPN
• Kree Blakeman
• Benjamin Ryan Blakeslee, D.O.
• Asia M Blakey
• Ericka L Blakey
• Leuviah Blakma

• Clinical Psychologist in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.