Healthcare Provider Details

I. General information

NPI: 1104619675
Provider Name (Legal Business Name): TASHA BLANCHARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6652 S UNIVERSITY AVE
CHICAGO IL
60637-6701
US

IV. Provider business mailing address

6652 S UNIVERSITY AVE
CHICAGO IL
60637-6701
US

V. Phone/Fax

Practice location:
  • Phone: 773-712-6104
  • Fax:
Mailing address:
  • Phone: 773-712-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: