MEDICARE: BLAKE BALTAZAR

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

General Provider Information

NPI Number	:	1841653466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE BALTAZAR

Provider Business Mailing Address
First Line	:	738 W CALIFORNIA TER
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60657-4517
Country	:	US
Telephone Number	:	516-355-1572
Fax Number	:

Provider Business Practice Location Address
First Line	:	738 W CALIFORNIA TER
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60657-4517
Country	:	US
Telephone Number	:	516-355-1572
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

Similar Medicare Providers

1326993627 — BREI TAYLOR LSW
Practice Location Address:

4614 S LAKE PARK AVE APT 1W
CHICAGO, IL
60653-4517

Practice Phone: 312-772-2562
Practice Fax:

1538417282 — MR. DEREK PALMER MA, CCC-SLP, BCS-S
Practice Location Address:

5758 S MARYLAND AVE , DCAM 4517, MC9020
CHICAGO, IL
60637-1426

Practice Phone: 773-702-4004
Practice Fax:

1285251009 — JJO TRANSLATIONS CORP
Practice Location Address:

5945 S KOMENSKY AVE
CHICAGO, IL
60629-4517

Practice Phone: 773-946-2074
Practice Fax:

1952141673 — SHARON CAMPOS-MARTINEZ
Practice Location Address:

5945 S KOMENSKY AVE
CHICAGO, IL
60629-4517

Practice Phone: 773-240-5377
Practice Fax:

1780570135 — SHEFALEV VR LLC
Practice Location Address:

2632 W MORSE AVE
CHICAGO, IL
60645-4517

Practice Phone: 718-517-1549
Practice Fax:

1346195864 — XAVIERA GOMEZ PIMIENTA ORLEANSKY
Practice Location Address:

535 W CORNELIA AVE APT 504
CHICAGO, IL
60657-2706

Practice Phone: 331-226-6003
Practice Fax:

Directions to “ BLAKE BALTAZAR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.