Provider Demographics
NPI:1790170462
Name:BLAKE, RACHEL TAYLOR
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TAYLOR
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOUNT MORRIS PARK W APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6394
Mailing Address - Country:US
Mailing Address - Phone:570-574-7694
Mailing Address - Fax:
Practice Address - Street 1:5 MOUNT MORRIS PARK W APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6394
Practice Address - Country:US
Practice Address - Phone:570-574-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist