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General NPI Number Information
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NPI Number | 1285466698
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Entity Type | Individual
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Provider Name | MICHELLE RENE BLEASHKA
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Gender | Female
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 24647 N MILWAUKEE AVE # 1576
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City | VERNON HILLS
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State | IL
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Zip | 60061-1567
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Country | US
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Telephone | 847-377-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 38276 N 5TH AVE
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City | SPRING GROVE
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State | IL
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Zip | 60081-9202
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Country | US
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Telephone | 224-280-3422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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