Provider Demographics
NPI:1164208955
Name:WIMMER, BLAKE B (AUD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:B
Last Name:WIMMER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD NEWPORT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4234
Mailing Address - Country:US
Mailing Address - Phone:949-642-7925
Mailing Address - Fax:949-642-2950
Practice Address - Street 1:500 OLD NEWPORT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4234
Practice Address - Country:US
Practice Address - Phone:949-642-7925
Practice Address - Fax:949-642-2950
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist