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Individual
JENNIFER KAY BLAKE
Active
Individual
JENNIFER KAY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
C5663
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972620110
NPI
OR
05
—
500663059
—
OR
Enumeration date
03/23/2007
Last updated
05/28/2020
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