Healthcare Provider Details

I. General information

NPI: 1093650541
Provider Name (Legal Business Name): ANDREA BLOSE DOBKIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 W CHICAGO AVE STE 202
CHICAGO IL
60622-4377
US

IV. Provider business mailing address

107 ROBIN BIRD LN
WHEELING WV
26003-9504
US

V. Phone/Fax

Practice location:
  • Phone: 312-283-4347
  • Fax: 312-577-0705
Mailing address:
  • Phone: 312-283-4347
  • Fax: 312-577-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: