| NPI | 1891332722 |
|---|---|
| Former Name | JESSICA ANNE BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 22568) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 22568) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2023-07-19 |