JUDI ELLEN BLAKE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009438

License Status

ACTIVE

Business

First Name

JUDI

Middle

ELLEN

Last Name

BLAKE

Business Name

JUDI ELLEN BLAKE

Original Issue Date

12/03/2022

Effective Date

02/09/2026

Expiration Date

03/01/2028

City

HAWTHORN WOODS

State

Zip

60047

Ever Disciplined

LastModifiedDate

02/09/2026