Individual
SCOTT WALTER BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
235 S 3RD ST, SHELTON, WA 98584-2255
(360) 426-0890
Mailing address
15838 104TH AVE SE, YELM, WA 98597-9567
(585) 219-3157
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61479679
WA
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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