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General NPI Number Information
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NPI Number | 1609266584
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Entity Type | Individual
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Provider Name | CHRISTOPHER RAY WLASCHIN LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 1801 AMERICAN BLVD E STE 1
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1230
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Country | US
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Telephone | 952-767-2279
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Fax | 612-728-5301
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Provider Business Mailing Address
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Address Line | 4612 33RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-3829
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Country | US
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Telephone | 612-709-7375
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Fax | 612-728-5301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21148
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License Number State | MN
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