Individual
BLAKE ILYSA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
139 E 35TH ST, 5E, NEW YORK, NY 10016-4176
(516) 410-8452
Mailing address
139 E 35TH ST, 5E, NEW YORK, NY 10016-4176
(516) 410-8452
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015114
NY
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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