Basic Information
| Provider Information | |||||||||
| NPI: | 1427273234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAKE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS CCC SP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 SOUTH MAIN STREET | ||||||||
| Address2: | SUITE 315 INVO HEALTHCARE ASSOCIATES | ||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 SOUTH MAIN STREET | ||||||||
| Address2: | SUITE 315 INVO HEALTHCARE ASSOCIATES | ||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL004083L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1011034350001 | 01 | PA | MA NUMBER | OTHER |