Individual ProviderShantelle Denise BlackburnSocial WorkerBehavioral Health & Social Service ProvidersPractice Address645 Wool Creek Dr, San Jose, CA 95112-2617(408) 283-6000PECOS EnrollmentBased on the most recent information from CMS, provider Shantelle Denise Blackburn does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164192886Provider TypeIndividualFull NameBlackburn, Shantelle DeniseGenderFemaleSole ProprietorNoEnumeration Date9/14/2021Last Updated9/3/2024Contact InformationPractice LocationPractice Address645 Wool Creek Dr, San Jose, CA 95112-2617Phone(408) 283-6000FaxUnlisted FaxMailing LocationMailing Address645 Wool Creek Dr, San Jose, CA 95112-2617PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense114520CaliforniaCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense114520California