Individual
TIERRA DIANE BLAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 W GARFIELD BLVD # 3, CHICAGO, IL 60609-5214
(312) 843-9472
Mailing address
650 W GARFIELD BLVD # 3, CHICAGO, IL 60609-5214
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/16/2023
Last updated
11/16/2023
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