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General NPI Number Information
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NPI Number | 1811305626
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Entity Type | Individual
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Provider Name | BLAKE J ZWEIG M.A.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 801 SKOKIE BLVD STE 222
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City | NORTHBROOK
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State | IL
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Zip | 60062-4027
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Country | US
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Telephone | 847-400-8912
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 SHERMER RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-6729
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Country | US
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Telephone | 847-400-8912
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1882175
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License Number State | IL
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