Basic Information
| Provider Information | |||||||||
| NPI: | 1609266584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WLASCHIN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4612 33RD AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554063829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127097375 | ||||||||
| FaxNumber: | 6127285301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 AMERICAN BLVD E STE 1 | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527672279 | ||||||||
| FaxNumber: | 6127285301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 01/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21148 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.