Provider Demographics
NPI:1679121396
Name:PERSON, BLAIR VALENTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:VALENTINE
Last Name:PERSON
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 1:400 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5055
Mailing Address - Country:US
Mailing Address - Phone:317-209-6393
Mailing Address - Fax:
Practice Address - Street 1:5006 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2906
Practice Address - Country:US
Practice Address - Phone:224-601-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015005235Z00000X
IL146015005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist