Individual
BLAKE ASHLEY LEWIS BUCHANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2995 WARRIOR LN, POPLAR BLUFF, MO 63901-8600
(573) 712-2902
Mailing address
2995 WARRIOR LN, POPLAR BLUFF, MO 63901-8600
(573) 712-2902
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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