Provider Demographics
NPI:1770009805
Name:BLUME, NANCY (MS, EDS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BLUME
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FALCON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2200
Mailing Address - Country:US
Mailing Address - Phone:630-972-9240
Mailing Address - Fax:
Practice Address - Street 1:777 FALCON RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2200
Practice Address - Country:US
Practice Address - Phone:630-972-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool