Individual
MS. MARTHA L BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST, NCPSYT
Contact information
Practice address
I-5 BETWEEN HWY 217 AND I-205, TUALATIN, OR 97062-9773
(503) 691-6391
(503) 691-8451
Mailing address
I-5 BETWEEN HWY 217 AND I-205, TUALATIN, OR 97062-9773
(503) 691-6391
(503) 691-8451
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
0003361
NY
103T00000X
Psychologist
Primary
1824
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003361
LICENSE
NY
Enumeration date
07/17/2006
Last updated
12/16/2013
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