Individual
JOHN C BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 PEARL AVE STE 102, OSHKOSH, WI 54901-4811
(414) 345-7781
(866) 496-2680
Mailing address
2844 MONTCLAIR PL, OSHKOSH, WI 54904-8944
(414) 345-7781
(866) 496-2680
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0017165
WI
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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