JUDI ELLEN BLAKE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****30

License Status

ACTIVE

Business

First Name

JUDI

Middle

ELLEN

Last Name

BLAKE

Business Name

JUDI ELLEN BLAKE

Original Issue Date

02/02/2023

Effective Date

02/09/2026

Expiration Date

03/01/2028

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/09/2026