Individual
PATRICIA J BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10506 BURT CIR, SUITE 100, OMAHA, NE 68114-2094
(402) 493-4444
(402) 493-1550
Mailing address
10506 BURT CIR, SUITE 100, OMAHA, NE 68114-2094
(402) 493-4444
(402) 493-1550
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
526
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08397
BC BS OF NE PROVIDER ID
NE
01
—
103314
VALUE OPTIONS PROVIDER ID
NE
Enumeration date
06/29/2006
Last updated
07/08/2007
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