Individual
BLAKE A BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
708 CHURCH ST STE 223, EVANSTON, IL 60201-3881
(312) 620-0396
Mailing address
1649 W PRATT BLVD APT 3B, CHICAGO, IL 60626-4127
(309) 540-8401
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.024395
IL
Other
Enumeration date
01/03/2024
Last updated
07/02/2025
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