Healthcare Provider Details

I. General information

NPI: 1336576826
Provider Name (Legal Business Name): KOLLEEN BLUME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 N WESTERN AVE
CHICAGO IL
60659-2009
US

IV. Provider business mailing address

6301 N WESTERN AVE
CHICAGO IL
60659-2009
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-0300
  • Fax: 773-761-0009
Mailing address:
  • Phone: 773-761-0300
  • Fax: 773-761-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number178.008456
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.008456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: