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1710768577
SCOTT WALTER BLAKE
SHELTON, WA
NPI
1710768577
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA 61479679)
Enumeration Date
2023-10-09
Last Update Date
2023-10-09
Business Address
SCOTT WALTER BLAKE SUDPT
235 S 3RD ST
SHELTON, WA 98584-2255
Phone number: 360-426-0890
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Mailing Address
SCOTT WALTER BLAKE SUDPT
15838 104TH AVE SE
YELM, WA 98597-9567
Phone number: 585-219-3157
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