1477605673 NPI number — MRS. VICKI L DEN EXTER BLOKLAND LCPC

Table of content: MRS. VICKI L DEN EXTER BLOKLAND LCPC (NPI 1477605673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477605673 NPI number — MRS. VICKI L DEN EXTER BLOKLAND LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEN EXTER BLOKLAND
Provider First Name:
VICKI
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477605673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 THREE OAKS RD
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-962-0547
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 THREE OAKS RD STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60013-6119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-704-2359
Provider Business Practice Location Address Fax Number:
847-223-6431
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180000707 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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