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General NPI Number Information
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NPI Number | 1831337807
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Entity Type | Individual
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Provider Name | AVA LAVON BLALARK LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 18W101 STANDISH LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3644
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Country | US
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Telephone | 773-469-5499
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Fax |
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Provider Business Mailing Address
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Address Line | 18W101 STANDISH LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3644
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Country | US
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Telephone | 773-469-5499
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 2246775
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017574
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License Number State | IL
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