Provider Demographics
NPI:1811507569
Name:BLAKE, ALEXIS PAIGE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:PAIGE
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 1:807 SKIDMORE RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9325
Mailing Address - Country:US
Mailing Address - Phone:740-529-1184
Mailing Address - Fax:740-529-4118
Practice Address - Street 1:4342 GALLIA ST STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5563
Practice Address - Country:US
Practice Address - Phone:740-529-1184
Practice Address - Fax:740-576-4118
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator