Individual
JOHNATHAN TRENT BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 N HARLEM AVE, OAK PARK, IL 60302-1250
(630) 632-4350
Mailing address
1515 N HARLEM AVE, OAK PARK, IL 60302-1250
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-308678
IL
Other
Enumeration date
12/06/2023
Last updated
12/06/2023
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