| Doctor Name: | ROGER BLANCHARD |
| NPI Number: | 1073536793 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | 1045-123 |
| Business Practice Address: | 101 E Pier St Port Washington, WI - 530741939 |
| Business Phone Number: | 2622843117 |
| Business Fax Number: | 2622843087 |
| Mailing Address: | 285 N Janacek Rd, BROOKFIELD |
| State: | WI |
| Postal Code: | 530456102 |
| Phone Number: | 2626419050 |
| Fax Number: | 2626419126 |
| NPI Enumeration Date: | 07/25/2006 |
| NPI Last Update Date: | 01/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1045-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |