Individual
ANDREW BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
1200 E 3900 S, SALT LAKE CITY, UT 84124-1300
(801) 293-6800
Mailing address
2170 S MCCLELLAND ST APT 320, SALT LAKE CITY, UT 84106-1018
(208) 891-1856
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12379664-4102
UT
Other
Enumeration date
01/22/2024
Last updated
03/04/2025
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