JASON JOSEF BLAKE

LOVES PARK, IL
NPI1780730101
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: IL  149.010637)
Enumeration Date2007-01-26
Last Update Date2007-07-08
Business Address
-- JASON JOSEF BLAKE LCSW
7124 WINDSOR LAKE PKWY SUITE # 10
LOVES PARK, IL 61111-3800
Phone number: 815-988-3142
Mailing Address
-- JASON JOSEF BLAKE LCSW
7124 WINDSOR LAKE PKWY SUITE # 10
LOVES PARK, IL 61111-3800
Phone number: 815-988-3142
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