Individual
MRS. JULIE E BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
179 STATION PLACE WAY, HURRICANE, WV 25526-8747
(304) 760-6300
(304) 201-5123
Mailing address
PO BOX 450, SCOTT DEPOT, WV 25560-0450
(304) 760-6300
(304) 201-5123
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-759
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1712303
BLUE CROSS BLUE SHIELD
WV
01
—
311504453
ACORDIA
WV
01
—
31150445300
WORKERS COMP
WV
01
—
6147520
CIGNA
WV
05
—
9400072-000
—
WV
Enumeration date
12/15/2006
Last updated
07/15/2009
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