Individual
CHRISTOPHER BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MACCCSLP
Contact information
Practice address
2795 PILOT KNOB RD, SUITE #100, EAGAN, MN 55121-1119
(651) 994-9644
(651) 994-8962
Mailing address
4058 DEERWOOD TRL, EAGAN, MN 55122-1889
(651) 994-9644
(651) 994-8962
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6349
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442612600
—
MN
01
—
4600244
MEDICA
MN
01
—
962S9BL
BCBS
MN
01
—
HP32576
HEALTH PARTNERS
MN
Enumeration date
02/06/2007
Last updated
11/30/2015
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