Healthcare Provider Details

I. General information

NPI: 1801808696
Provider Name (Legal Business Name): BLENDING FAMILIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E GRAND AVE
LAKE VILLA IL
60046-9043
US

IV. Provider business mailing address

217 E GRAND AVE
LAKE VILLA IL
60046-9043
US

V. Phone/Fax

Practice location:
  • Phone: 224-456-0345
  • Fax: 847-838-9907
Mailing address:
  • Phone: 224-456-0345
  • Fax: 847-838-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number180002096
License Number StateIL

VIII. Authorized Official

Name: KATIE ANGEL
Title or Position: OWNER
Credential: L.C.P.C.
Phone: 847-838-9904