Robert W. Blazich, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2498-123 Issued in WI

Practice address

11501 N Port Washington Rd
Suite 202
Mequon, WI 53092-3465

Phone

(262) 241-7778

Fax

(262) 241-1012

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710005483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11501 N PORT WASHINGTON RD",
            "address_2": "SUITE 202",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923465",
            "telephone_number": "262-241-7778",
            "fax_number": "262-241-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11501 N PORT WASHINGTON RD",
            "address_2": "SUITE 202",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923465",
            "telephone_number": "262-241-7778",
            "fax_number": "262-241-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZICH",
        "first_name": "ROBERT",
        "middle_name": "W.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2498-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Birmingham, DPT
• Dawnmarie Bischel, OT
• Pranaya Bista
• Grace Bittman
• Jan M Blanchard, RPH
• Sean Joseph Blazier, LAT, ATC, USAT
• Roberta L. Bloch, M.S.CCC/SLP
• Karen Irene Block, CRT
• Byron C Bloemer, PH.D.
• Kelly Marie Blonien, CRNA

• Clinical Social Worker in Mequon, WI
• Providers in Mequon, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.