Individual
DR. LESLEY M. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
850 MAPLE STREET, MEDICAL LAKE, WA 99022
(509) 299-3121
(509) 299-7015
Mailing address
PO BOX 800, MEDICAL LAKE, WA 99022-0800
(509) 299-3121
(509) 299-7015
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00043593
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8421471
—
WA
Enumeration date
10/20/2005
Last updated
07/09/2007
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