Healthcare Provider Details

I. General information

NPI: 1417870346
Provider Name (Legal Business Name): TYLER BLISS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 METRO DR
SCHOFIELD WI
54476-2379
US

IV. Provider business mailing address

1442 BUREK AVE
WAUSAU WI
54401-2109
US

V. Phone/Fax

Practice location:
  • Phone: 715-571-1566
  • Fax:
Mailing address:
  • Phone: 715-348-2300
  • Fax: 715-348-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84429
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: