| Blake Self, CCC-SLP | |
|
5704 Wonder Woods Drive, Wonder Lake, IL 60097 | |
| (847) 636-7603 | |
| Not Available |
| Full Name | Blake Self |
|---|---|
| Gender | Male |
| Speciality | Speech-language Pathologist |
| Location | 5704 Wonder Woods Drive, Wonder Lake, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164887592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 235Z00000X | Speech-language Pathologist | 146012447 (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Self, CCC-SLP 5704 Wonder Woods Drive, Wonder Lake, IL 60097 Ph: (847) 636-7603 | Blake Self, CCC-SLP 5704 Wonder Woods Drive, Wonder Lake, IL 60097 Ph: (847) 636-7603 |
Mrs. Lois Jean Wenkel, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 5622 Woodlane Dr, Wonder Lake, IL 60097 Phone: 815-653-9068 Fax: 815-846-0693 | |
Kristi Newman, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 6809 Mccullom Lake Rd, Wonder Lake, IL 60097 Phone: 815-653-2311 | |
Driscoll Pediatric Speech Services, Inc. Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 7709 Catalpa Dr, Wonder Lake, IL 60097 Phone: 815-342-7957 Fax: 815-653-4842 |