NPI 1134924475

John C Blake

Practitioner Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Oshkosh, WI

Practice location

Address: 50 Pearl Ave STE 102, Oshkosh, WI 54901-4811
Phone: (414) 345-7781
Fax: (866) 496-2680
Mailing address: 2844 Montclair Pl, Oshkosh, WI 54904-8944

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 0017165 (WI)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Wisconsin →

Registry record

NPI: 1134924475
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Feb 2025
Record last updated: 19 Feb 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.