Provider Demographics
NPI:1124464409
Name:BLAKE, ASHLEY R (AUD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:BLAKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 MIFFLIN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8848
Mailing Address - Country:US
Mailing Address - Phone:419-289-8919
Mailing Address - Fax:419-289-9563
Practice Address - Street 1:2212 MIFFLIN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8848
Practice Address - Country:US
Practice Address - Phone:419-289-8919
Practice Address - Fax:419-289-9563
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01787237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter