Healthcare Provider Details

I. General information

NPI: 1396678934
Provider Name (Legal Business Name): LISA MARIE BLANKENSHIP LPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W RENWICK RD STE 200
PLAINFIELD IL
60544-8733
US

IV. Provider business mailing address

7925 NEVA AVE
BURBANK IL
60459-1614
US

V. Phone/Fax

Practice location:
  • Phone: 815-683-8700
  • Fax: 815-234-1550
Mailing address:
  • Phone: 815-683-8700
  • Fax: 815-234-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: