Edward Blake

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

365 Kuck LN
Petaluma, CA 94952-9606

Phone

(707) 795-6954

NPI assigned

Jul 21, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1124435227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 KUCK LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949529606",
            "telephone_number": "707-795-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 KUCK LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949529606",
            "telephone_number": "707-795-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corey Biava
• Janice Biggs
• Bio-Medical Applications of California, Inc.
• Shradha Biradar, DO
• Jessica Betsy Rose Biskind Silverman, LPC, MFT
• Gracie Bleck
• Karen B. Bloom, MD
• Blossom Pediatric Speech Therapy
• Kyra Lynn Blumberg
• Bob Koenitzer DDS, Inc.

• All providers in Petaluma, CA
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.