Provider Demographics
NPI:1962234625
Name:DALEY, BLAKE
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:DALEY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 STATION ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4943
Mailing Address - Country:US
Mailing Address - Phone:216-245-7688
Mailing Address - Fax:
Practice Address - Street 1:8500 STATION ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4943
Practice Address - Country:US
Practice Address - Phone:216-245-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty