Individual
BLAKE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5114 W 87TH ST S, HAYSVILLE, KS 67060-7335
(970) 310-6540
Mailing address
3414 E CENTRAL AVE, WICHITA, KS 67208-3280
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/04/2025
Last updated
03/04/2025
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