Provider Demographics
NPI:1457544819
Name:BLAIN, DAUN DENISE
Entity Type:Individual
Prefix:MS
First Name:DAUN
Middle Name:DENISE
Last Name:BLAIN
Suffix:
Gender:F
Credentials:
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 ST STE 228
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3371
Mailing Address - Country:US
Mailing Address - Phone:224-433-9932
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:228
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:224-433-9932
Practice Address - Fax:847-548-8083
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional