Individual
IDELL BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1916 TOSCANINI WAY, NORTH LAS VEGAS, NV 89032-0651
(702) 690-5422
Mailing address
1916 TOSCANINI WAY, NORTH LAS VEGAS, NV 89032-0651
(702) 690-5422
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1401687641
NV
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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