BLAKE SELF CCC-SLP
NPI 1164887592
Speech-Language Pathologist in Wonder Lake, IL

Q: What is Blake Self's NPI number?

The NPI number for Blake Self is 1164887592. It was assigned to this individual provider in the NPPES registry on December 30, 2015.

Q: What is Blake Self's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Q: When was this NPI record last updated?

The NPPES record for Blake Self was last updated on December 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 30, 2015

5704 WONDER WOODS DRIVE, WONDER LAKE, IL 60097(847) 636-7603 Get Directions Write a Review

NPPES record last updated: December 30, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Blake Self Ccc-slp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE SELF CCC-SLP (NPI 1164887592) is an individual speech-language pathologist provider in Wonder Lake, Illinois, licensed in Illinois (146012447) and active in the NPI registry since December 2015.

NPPES Registry Identity

NPI1164887592

Entity TypeIndividualMale

Primary Taxonomy235Z00000X

Provider Legal NameBLAKE SELFCredential: CCC-SLP

Location Address5704 WONDER WOODS DRIVEWonder Lake, IL 60097

Mailing Address5704 Wonder Woods DriveWonder Lake, IL 60097 · (847) 636-7603

Phone(847) 636-7603

Sole ProprietorYes

Enumeration DateDecember 30, 2015

✔ NPI 1164887592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers

Taxonomy Code235Z00000X

License✔ Licensed in IL · 146012447

Definition

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

5704 WONDER WOODS DRIVE, Wonder Lake, IL 60097

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Self's NPI number?

The NPI number for Blake Self is 1164887592. It was assigned to this individual provider in the NPPES registry on December 30, 2015.

Where is Blake Self located?

Blake Self practices at 5704 Wonder Woods Drive, Wonder Lake, IL 60097. The listed phone number is (847) 636-7603.

What is Blake Self's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

When was this NPI record last updated?

The NPPES record for Blake Self was last updated on December 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.