Provider Demographics
NPI:1952084915
Name:BLAKE, OLIVIA RACHEL
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RACHEL
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 1:701 W WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5234
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 W WETMORE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5234
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant