Individual
JEFFREY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
474 W 200 N, ST GEORGE, UT 84770-4505
(435) 634-5600
Mailing address
474 W 200 N, ST GEORGE, UT 84770-4505
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/20/2017
Last updated
06/14/2017
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