Healthcare Provider Details

I. General information

NPI: 1720799026
Provider Name (Legal Business Name): HANNAH M BLAKE SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 NE 7TH AVE STE B223-A
VANCOUVER WA
98685-4523
US

IV. Provider business mailing address

330 E MILL PLAIN BLVD APT 515
VANCOUVER WA
98660-2877
US

V. Phone/Fax

Practice location:
  • Phone: 971-236-2831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSP61191872
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: