MEDICARE: MRS. JAMIE LEE BLAKEMAN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178.009508	IL
2	101YP2500X	Professional Counselor	180.009996	IL

General Provider Information

NPI Number	:	1114358199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LEE BLAKEMAN LCPC

Provider Business Mailing Address
First Line	:	1717 CUDDY DR
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-6000
Country	:	US
Telephone Number	:	217-779-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W WHITE OAKS DR STE D
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	217-779-7496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	04/30/2022

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