Individual
LISA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11111 HOUZE RD, SUITE 101, ROSWELL, GA 30076-5663
(770) 998-9599
(770) 645-1313
Mailing address
11111 HOUSE ROAD, SUITE 101, ROSWELL, GA 30076
(770) 998-9599
(770) 645-1313
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006806
GA
Other
Enumeration date
04/25/2008
Last updated
04/25/2008
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