Individual
SALLY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
(608) 280-2294
Mailing address
2500 OVERLOOK TER, MADISON, WI 53705-2254
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1041-122
WI
Other
Enumeration date
01/19/2018
Last updated
01/19/2018
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