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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164627006 NPPES
Wisconsin Other 1043-154 STATE LICENSE
Wisconsin MEDICAID 42717700 STATE LICENSE

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