Individual
BLAKE BALTAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
738 W CALIFORNIA TER, UNIT 1, CHICAGO, IL 60657-4517
(516) 355-1572
Mailing address
738 W CALIFORNIA TER, UNIT 1, CHICAGO, IL 60657-4517
(516) 355-1572
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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