Individual
GRACE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 E SUPERIOR ST STE 306, CHICAGO, IL 60611-2595
(312) 754-9404
(312) 754-9402
Mailing address
1650 HARVARD ST NW APT 121, WASHINGTON, DC 20009-3726
(603) 724-1870
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/18/2026
Last updated
06/02/2026
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