JENNIFER KING BLACKLEDGE PH.D.
NPI 1326285743
Psychologist in Roanoke, TX

Active since January 08, 2009Opted out of Medicare · through Apr 1, 2027
209 TRAVIS ST, STE 105, ROANOKE, TX 76262(817) 988-9121 Get Directions Write a Review

NPPES record last updated: March 7, 2014. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Jennifer King Blackledge Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIFER KING BLACKLEDGE PH.D. (NPI 1326285743) is an individual psychologist in Roanoke, Texas, licensed in Texas (33692) and active in the NPI registry since January 2009. She has opted out of Medicare through April 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1326285743
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameJENNIFER KING BLACKLEDGECredential: PH.D.
Location Address209 TRAVIS ST, STE 105Roanoke, TX 76262-8661
Mailing Address209 Travis St, Ste 105Roanoke, TX 76262-8661 · (817) 988-9121
Sole ProprietorYes
Enumeration DateJanuary 8, 2009
Last NPPES UpdateMarch 7, 2014
NPI 1326285743 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in TX · 33692
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
209 TRAVIS ST, Roanoke, TX 76262

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Jennifer King Blackledge Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2013 through April 1, 2027.

Opt-Out Effective DateApril 1, 2013
Opt-Out In Effect ThroughApril 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
209 TRAVIS ST, SUITE 102
ROANOKE, TX 76262
Counselor (Mental Health)
209 TRAVIS ST, SUITE 102
ROANOKE, TX 76262
Psychologist (Clinical)
209 TRAVIS ST
ROANOKE, TX 76262
Psychologist (Counseling)
209 TRAVIS ST
ROANOKE, TX 76262

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jennifer Blackledge's NPI number?

The NPI number for Jennifer Blackledge is 1326285743. It was assigned to this individual provider in the NPPES registry on January 8, 2009.

Where is Jennifer Blackledge located?

Jennifer Blackledge practices at 209 Travis St Ste 105, Roanoke, TX 76262. The listed phone number is (817) 988-9121.

What is Jennifer Blackledge's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Jennifer Blackledge enrolled in Medicare?

No. Jennifer Blackledge has opted out of Medicare through April 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jennifer Blackledge was last updated on March 7, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.