Healthcare Provider Details

I. General information

NPI: 1710804737
Provider Name (Legal Business Name): RANELL ANN BLUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 W CRYSTAL LAKE RD STE B
MCHENRY IL
60050-4299
US

IV. Provider business mailing address

3902 SCHUETTE DR
WONDER LAKE IL
60097-8146
US

V. Phone/Fax

Practice location:
  • Phone: 815-276-9422
  • Fax:
Mailing address:
  • Phone: 815-276-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.023937
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: