Individual
RONALD ELMER BLAKE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
721 W MAPLE ST, RAWLINS, WY 82301-5447
(307) 324-7156
Mailing address
721 W MAPLE ST, RAWLINS, WY 82301-5447
(307) 324-7156
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-555
WY
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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