Individual
DR. TERRY CORNELIUS BLANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9548 S FOREST AVE, CHICAGO, IL 60628-1406
(773) 663-9676
Mailing address
9548 S FOREST AVE, CHICAGO, IL 60628-1406
(773) 663-9676
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
178001564
IL
Other
Enumeration date
05/21/2015
Last updated
05/21/2015
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