Healthcare Provider Details

I. General information

NPI: 1265348171
Provider Name (Legal Business Name): HAYLEY BLOMQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 N LINCOLN AVE FL 1
CHICAGO IL
60625-2585
US

IV. Provider business mailing address

6301 N SHERIDAN RD APT 4E
CHICAGO IL
60660-1708
US

V. Phone/Fax

Practice location:
  • Phone: 312-401-6574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: