Provider Demographics
NPI:1861676041
Name:BLAKE, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
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 1:27 WORSTED ST
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3039
Mailing Address - Country:US
Mailing Address - Phone:978-973-5150
Mailing Address - Fax:
Practice Address - Street 1:44 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1904
Practice Address - Country:US
Practice Address - Phone:978-537-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist