BLAKE WESLEY SELF Speech-Language Pathologist License verification

Business Entity

CANCELLED

License Type

Speech-Language Pathologist

Description

LICENSED SPEECH LANGUAGE PATHOLOGY TEMPORARY

License Number

242002691

License Status

CANCELLED

Business

First Name

BLAKE

Middle

WESLEY

Last Name

SELF

Business Name

BLAKE WESLEY SELF

Original Issue Date

07/08/2013

Effective Date

07/08/2013

Expiration Date

07/08/2014

City

CRYSTAL LAKE

State

Zip

60012

County

MCHENRY

Ever Disciplined

LastModifiedDate

03/13/2015