Individual
BETH BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
205 BLANEY AVE, MOUNDSVILLE, WV 26041-1006
(304) 281-8099
Mailing address
205 BLANEY AVE, MOUNDSVILLE, WV 26041-1006
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-0683
WV
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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