Basic Information
Provider Information
NPI: 1316174543
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLONSKY-SANCHEZ
FirstName: KAREN
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BLONSKY
OtherFirstName: KAREN
OtherMiddleName: J.
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LCSW
OtherLastNameType: 1
Mailing Information
Address1: 1044 N MOZART ST STE 203
Address2:  
City: CHICAGO
State: IL
PostalCode: 606222792
CountryCode: US
TelephoneNumber: 7732925951
FaxNumber: 7732922601
Practice Location
Address1: 1044 N MOZART ST STE 203
Address2:  
City: CHICAGO
State: IL
PostalCode: 606222792
CountryCode: US
TelephoneNumber: 7732925951
FaxNumber: 7732922601
Other Information
ProviderEnumerationDate: 06/15/2009
LastUpdateDate: 06/15/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149012814ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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