Provider Demographics
NPI:1396822367
Name:BLECHA, JERRY A (MS, LCPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:A
Last Name:BLECHA
Suffix:
Gender:M
Credentials:MS, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N. GREENLEAF
Mailing Address - Street 2:#212
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:224-398-3117
Mailing Address - Fax:
Practice Address - Street 1:135 N. GREENLEAF
Practice Address - Street 2:#212
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:224-398-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health