Individual
MS. MARISSA ANNE BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
310 N LOOMIS ST, CHICAGO, IL 60607-1147
(312) 243-8487
Mailing address
310 N LOOMIS ST, CHICAGO, IL 60607-1147
(312) 243-8487
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/22/2018
Last updated
01/16/2019
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