Individual
MS. KENNETH LEON BLAKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
2392 EDGEWOOD AVE N, JACKSONVILLE, FL 32254-1725
(904) 781-7797
Mailing address
2392 EDGEWOOD AVE N, JACKSONVILLE, FL 32254-1725
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Enumeration date
12/08/2025
Last updated
12/11/2025
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