Provider Demographics
NPI:1780792606
Name:BLECHMAN, GERALD AARON (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:AARON
Last Name:BLECHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8196
Mailing Address - Country:US
Mailing Address - Phone:630-690-5065
Mailing Address - Fax:630-690-5302
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8196
Practice Address - Country:US
Practice Address - Phone:630-690-5065
Practice Address - Fax:630-690-5302
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL81608Medicare ID - Type Unspecified