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NPI Code Detail

MEDICARE: MCKENNA BLAKE

MEDICARE: MCKENNA BLAKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1629924857
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENNA BLAKE
Provider Business Mailing Address
First Line : 21700 GOLDEN TRIANGLE RD STE 201
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91350-2954
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 21700 GOLDEN TRIANGLE RD STE 201
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91350-2954
Country : US
Telephone Number : 800-820-7813
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ MCKENNA BLAKE ” Practice Location

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