Individual
GRACIE RENEE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1109 FAYETTEVILLE RD, VAN BUREN, AR 72956-3363
(479) 474-6444
Mailing address
12822 HIGHWAY 217, CHARLESTON, AR 72933-8005
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/13/2025
Last updated
05/13/2025
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