Jennifer Marie Van Blake, MHS-CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Mount Prospect, IL
NPI 1306267604 · NPPES record last updated Oct 31, 2025
Key facts
- NPI
- 1306267604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146.007253 (IL)
- Practice address
- 113 N School St
Mount Prospect, IL 60056-2540 - Phone
- (847) 350-8846
- NPI assigned
- Jan 4, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2001
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
7 Clyde Rd
Somerset, NJ 08873-5049
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140423000600 | IL | Practitioner - Qualified Speech Language Pathologist | 4981836178 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.007253 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehabilitation Services Il LLC | Speech-Language Pathologist | Current |
Accepting new patients |
| Path to Speech PLLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
7 Carnegie Plz
Cherry Hill, NJ 08003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.007253 | IL | Yes |
Addresses
Primary practice location
113 N School St
Mount Prospect, IL 60056-2540
Mailing address
113 N School St
Mount Prospect, IL 60056-2540
Phone (847) 350-8846
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation Services IL LLC |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation Services IL LLC |
Other providers in Mount Prospect, IL
- Urban Supply Inc
- Urban Supply Inc
- Uropartners, LLC
- Uropartners, LLC
- Mourette Valcin
- Van Driel'S Drug Store
- Van Driels Medical Support Wear Co
- James Edward Vanderbosch Jr.
- Lindy Vandersteeg
- Rockie Vanga
All providers in Mount Prospect, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.