Provider Demographics
NPI:1215399183
Name:WEBB, BLAKE JAMES (BCHIS)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:JAMES
Last Name:WEBB
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 S 1615 E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2521
Mailing Address - Country:US
Mailing Address - Phone:801-631-8436
Mailing Address - Fax:
Practice Address - Street 1:1471 DEWAR DR STE 143
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5815
Practice Address - Country:US
Practice Address - Phone:307-362-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist