Individual
AMY M BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
980 PARKSIDE VILLAGE LN, OSAGE BEACH, MO 65065-3098
(884) 031-0718
(573) 302-7369
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2003012111
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498800705
—
MO
Enumeration date
12/09/2005
Last updated
03/25/2021
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