Christopher Blake, MACCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6349 Issued in MN

Practice address

2795 Pilot Knob Rd
Suite #100
Eagan, MN 55121-1119

Phone

(651) 994-9644

Fax

(651) 994-8962

NPI assigned

Feb 6, 2007

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Therapy Center, Inc

  • Speech-Language Pathologist
  • Eagan, MN
  • NPI 1295809366
  Medicare reassignment NPD
• Children'S Therapy Ctr, Inc

  • Speech-Language Pathologist
  • Apple Valley, MN
  • NPI 1053450742
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1831238591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4058 DEERWOOD TRL",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221889",
            "telephone_number": "651-994-9644",
            "fax_number": "651-994-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2795 PILOT KNOB RD",
            "address_2": "SUITE #100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211119",
            "telephone_number": "651-994-9644",
            "fax_number": "651-994-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHRISTOPHER",
        "credential": "MACCCSLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "6349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "962S9BL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP32576",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "4600244",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442612600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Jean Bittner, MD
• Scott Bjerke, DDS
• Emily Kay Bjore, O.D.
• BKD Eagan, LLC
• Julia M Black, PT
• Grant Blasczyk, DPT, PT
• Rachel Blay
• Katherine Anne Blesener, MA, LPCC
• Isabella M Blett
• Hashi Blomgren

• Speech-Language Pathologist in Eagan, MN
• Providers in Eagan, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.