Healthcare Provider Details

I. General information

NPI: 1710961701
Provider Name (Legal Business Name): BOBBIE J BLESKEY LPC, CSAC, ICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S TOWNLINE RD
WAUTOMA WI
54982-6900
US

IV. Provider business mailing address

380 S TOWNLINE RD
WAUTOMA WI
54982-6900
US

V. Phone/Fax

Practice location:
  • Phone: 920-787-6550
  • Fax: 920-787-0421
Mailing address:
  • Phone: 920-787-6550
  • Fax: 920-787-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15352-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11144-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: