Individual
JESSICA NICOLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
19670 STATE ROAD 120, BRISTOL, IN 46507-9131
(574) 294-6197
(574) 296-9158
Mailing address
19670 STATE ROAD 120, BRISTOL, IN 46507-9131
(574) 294-6197
(574) 296-9158
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004183A
IN
Other
Enumeration date
04/24/2008
Last updated
04/24/2008
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