Provider Demographics
NPI:1942098207
Name:BLAKE, ROSLYNN
Entity type:Individual
Prefix:
First Name:ROSLYNN
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 HOLLYGLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-3311
Mailing Address - Country:US
Mailing Address - Phone:281-594-8759
Mailing Address - Fax:
Practice Address - Street 1:10221 HOLLYGLEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3311
Practice Address - Country:US
Practice Address - Phone:281-594-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist