Individual
TIMOTHY G BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
2649 PARK AVE, MINNEAPOLIS, MN 55407-1006
(612) 676-1604
(612) 379-8235
Mailing address
2649 PARK AVE, MINNEAPOLIS, MN 55407-1006
(612) 676-1604
(612) 379-8235
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5115
MN
Other
Enumeration date
09/22/2009
Last updated
03/11/2021
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