Provider Demographics
NPI:1316953953
Name:HOWARD BLASZAK, PAMELA (LPC, CSAC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:HOWARD BLASZAK
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-4006
Mailing Address - Country:US
Mailing Address - Phone:414-225-1512
Mailing Address - Fax:414-225-1575
Practice Address - Street 1:1216 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3061
Practice Address - Country:US
Practice Address - Phone:414-210-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13880-132101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42015900Medicaid