Blake, Maribeth
Blake, Maribeth is an individual health care provider with primary practice located at 2801 S Webster Ave , Green Bay WI 54301-2878. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Blake, Maribeth can be contacted via phone (920) 337-1122.Contact Information
Primary practice address
2801 S Webster Ave
Green Bay WI 54301-2878
Phone: (920) 337-1122
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 1043-154 | Wisconsin |
Profile Details
| NPI number | 1164627006 |
|---|---|
| LBN Legal business name | Blake, Maribeth |
| Credentials | M.S.CCC-SLP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2007 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164627006 | NPPES |
| Wisconsin | Other | 1043-154 | STATE LICENSE |
| Wisconsin | MEDICAID | 42717700 | STATE LICENSE |
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