Provider Demographics
NPI:1073247169
Name:BLENDER, ABBEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:BLENDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W OHIO ST APT 3208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7974
Mailing Address - Country:US
Mailing Address - Phone:248-444-6122
Mailing Address - Fax:
Practice Address - Street 1:135 N HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2622
Practice Address - Country:US
Practice Address - Phone:917-620-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.017365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist