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Individual

BLAKE EDES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
13075 W PERSIMMON LN STE 120, BOISE, ID 83713-1986
(208) 793-7006
(208) 793-7007
Mailing address
4628 W PASADENA LN APT 101, BOISE, ID 83705-6527

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-4067
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
263162410
ID
Enumeration date
11/27/2018
Last updated
03/31/2020
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