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Individual

MELISSA BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1924 W A ST, HASTINGS, NE 68901-5650
(402) 461-7578
Mailing address
2324 W 11TH ST, GRAND ISLAND, NE 68803-3622
(308) 384-0317

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
473600101
NE
Enumeration date
09/28/2016
Last updated
09/28/2016
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