| Whitney S Blakely Pc | |
|
415 S Mulford Rd Rockford IL 61108-3011 | |
| (815) 979-8164 | |
| (815) 399-5767 |
| Full Name | Whitney S Blakely Pc |
|---|---|
| Speciality | Social Worker |
| Location | 415 S Mulford Rd, Rockford, Illinois |
| Authorized Official Name and Position | Whitney S Blakely (THERAPIST) |
| Authorized Official Contact | 8159798164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitney S Blakely Pc 415 S Mulford Rd Rockford IL 61108-3011 Ph: (815) 979-8164 | Whitney S Blakely Pc 415 S Mulford Rd Rockford IL 61108-3011 Ph: (815) 979-8164 |
| NPI Number | 1184378762 |
|---|---|
| Provider Enumeration Date | 02/11/2022 |
| Last Update Date | 02/11/2022 |
| Certification Date | 02/11/2022 |
| Medicare PECOS PAC ID | 8022494731 |
|---|---|
| Medicare Enrollment ID | O20221004001931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184378762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Whitney S Blakely |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831532803 PECOS PAC ID: 0143548065 Enrollment ID: I20150406000440 |
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