Provider Demographics
NPI:1760984876
Name:BLAKE, CHRISTINA DANFORD (MED, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DANFORD
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DANFORD
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC/SLP
Mailing Address - Street 1:2884 SANIBEL LN
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9449
Mailing Address - Country:US
Mailing Address - Phone:419-365-1625
Mailing Address - Fax:
Practice Address - Street 1:7150 GRANITE CIR STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3114
Practice Address - Country:US
Practice Address - Phone:419-843-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty