Blake Prochnow
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Prescott, WI
NPI 1164093860 · NPPES record last updated Jul 5, 2021
Key facts
- NPI
- 1164093860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Practice address
- 1380 Walnut St
Prescott, WI 54021-1010 - Phone
- (612) 382-3458
- NPI assigned
- Jul 5, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Yes |
Addresses
Primary practice location
1380 Walnut St
Prescott, WI 54021-1010
Mailing address
1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 379-1752
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540321 | Medicaid | MN |
Other providers in Prescott, WI
- One Life Chiropractic LLC
- Orion Prescott LLC
- Premier Eye Care Prescott, LTD.
- Prescott Emergency Medical Service
- Prescott Family Dental
- Rae Chiropractic, LLC
- Sheila Scheele
- School District of Prescott
- Schueller Chiropractic Inc.
- Donald Burton Schueller
All providers in Prescott, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.