SCOTT WALTER BLAKE

SHELTON, WA
NPI1710768577
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA  61479679)
Enumeration Date2023-10-09
Last Update Date2023-10-09
Business Address
SCOTT WALTER BLAKE SUDPT
235 S 3RD ST
SHELTON, WA 98584-2255
Phone number: 360-426-0890
Mailing Address
SCOTT WALTER BLAKE SUDPT
15838 104TH AVE SE
YELM, WA 98597-9567
Phone number: 585-219-3157
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