Provider Demographics
NPI:1376981662
Name:BLAZIC, RACHELLE ANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:ANNE
Last Name:BLAZIC
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9407
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:
Practice Address - Street 1:724 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5001
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health