Blake Prochnow
Counselor, Addiction (Substance Use Disorder) in Prescott, WI. Individual provider (NPI-1).
NPI number1164093860
StatusActive
Last updated in NPPESJul 5, 2021
Details
- NPI
- 1164093860
- Entity type
- Individual (NPI-1)
- Name
- Blake Prochnow
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 5, 2021
- Certification date
- Jul 5, 2021
- Last updated
- Jul 5, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
1380 Walnut StPrescott, WI 54021-1010
Phone 612-382-3458
Mailing address
1900 Silver Lake Rd Nw Ste 110New Brighton, MN 55112-1789
Phone 651-379-1752
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