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1346909991
SPENCER THOMAS BLAKE
AMES, IA
NPI
1346909991
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IA t20064)
Enumeration Date
2021-12-10
Last Update Date
2021-12-10
Business Address
SPENCER THOMAS BLAKE
804 KELLOGG AVE
AMES, IA 50010-6234
Phone number: 515-233-4930
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Mailing Address
SPENCER THOMAS BLAKE
420 KELLOGG AVE
AMES, IA 50010-6226
Phone number: 515-233-3141
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