Individual
JESSICA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 WILMINGTON DR STE 220, DUPONT, WA 98327-8773
(253) 507-7004
Mailing address
2324 OAK DR, STEILACOOM, WA 98388-4114
(253) 459-5657
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/26/2024
Last updated
01/31/2026
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