Individual
STEPHANIE KUULEI BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
26 W HIDDEN HOLLOW DR, OREM, UT 84058-7497
(801) 836-6760
Mailing address
26 W HIDDEN HOLLOW DR, OREM, UT 84058-7497
(801) 836-6760
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
348922-3502
UT
Other
Enumeration date
10/04/2006
Last updated
02/20/2020
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