Provider Demographics
NPI:1902893217
Name:BLAKE, TERESA MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1854
Mailing Address - Country:US
Mailing Address - Phone:865-541-2020
Mailing Address - Fax:865-541-2019
Practice Address - Street 1:501 19TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1854
Practice Address - Country:US
Practice Address - Phone:865-541-2020
Practice Address - Fax:865-541-2019
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS