Individual
MR. BLAKE ANDREW NOWICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
4411 N HABANA AVE, TAMPA, FL 33614-7211
(813) 872-2771
Mailing address
4411 N HABANA AVE, TAMPA, FL 33614-7211
(813) 872-2771
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA17719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14227109
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
—
Enumeration date
05/19/2020
Last updated
05/19/2020
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