Individual
JONAH BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
844 S 800 W STE 210, PLEASANT GROVE, UT 84062-4567
(801) 923-3537
Mailing address
919 CALLIE CT, NORTH SALT LAKE, UT 84054-0165
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-474965
UT
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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