Individual
SPENCER THOMAS BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
804 KELLOGG AVE, AMES, IA 50010-6234
(515) 233-4930
Mailing address
420 KELLOGG AVE, AMES, IA 50010-6226
(515) 233-3141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T20064
IA
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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