Healthcare Provider Details

I. General information

NPI: 1386293744
Provider Name (Legal Business Name): DYLAN BLASCHKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 6TH ST
WAUSAU WI
54403-5519
US

IV. Provider business mailing address

806 N 6TH AVE
WAUSAU WI
54401-2831
US

V. Phone/Fax

Practice location:
  • Phone: 715-409-0672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13166-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: