Provider Demographics
NPI:1235577990
Name:BLOCHER, WEIMIN GRACE
Entity Type:Individual
Prefix:DR
First Name:WEIMIN
Middle Name:GRACE
Last Name:BLOCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:BLOCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:201 W SPRINGFIELD AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4880
Mailing Address - Country:US
Mailing Address - Phone:217-621-6180
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 211
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4880
Practice Address - Country:US
Practice Address - Phone:217-621-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008605103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical