Individual
BLAKE JAMES MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2650 W MONTROSE AVE STE 102, CHICAGO, IL 60618-1562
(773) 377-5261
Mailing address
2650 W MONTROSE AVE STE 102, CHICAGO, IL 60618-1562
(773) 377-5261
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149023395
IL
Other
Enumeration date
11/14/2017
Last updated
01/03/2024
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