Individual
COLLEEN M BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1120 RANDALL CT, GENEVA, IL 60134-3911
(630) 232-1070
(630) 232-1471
Mailing address
1120 RANDALL CT, GENEVA, IL 60134-3911
(630) 232-1070
(630) 232-1471
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/28/2010
Last updated
11/10/2011
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