Individual
BLAKE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8282 28TH CT NE STE A, LACEY, WA 98516-7162
(360) 915-6868
Mailing address
1399 GARDEN TERRACE RD, GEARHART, OR 97138-1000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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