Tiffany Antoinette Blackmon | Milwaukee, WI • PECOS Search

Tiffany Antoinette Blackmon

Social Worker

Behavioral Health & Social Service Providers

5000 W National Ave, Milwaukee, WI 53295-0001

(414) 384-2000 (414) 698-0797

PECOS Enrollment

Based on the most recent information from CMS, provider Tiffany Antoinette Blackmon does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1962097410
Provider Type
Individual
Full Name
Blackmon, Tiffany Antoinette
Title
Ms.
Credential
APSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/6/2021
Last Updated
3/6/2021

Contact Information

Practice Location

5000 W National Ave, Milwaukee, WI 53295-0001

Unlisted Fax

Mailing Location

8951 N Park Plaza Ct Apt 310, Brown Deer, WI 53223-2142

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 104100000X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 129895-121 Wisconsin