Individual
JUSTINA MARIE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 RUSSIAN OLIVE RD, NORTH PLATTE, NE 69101-6827
(308) 520-4460
Mailing address
6214 24TH AVE, BROOKLYN, NY 11204-3319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
3747P1801X
Personal Care Attendant
—
NE
Other
Enumeration date
08/03/2023
Last updated
08/09/2023
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