Individual
DAVID RANDALL BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(800) 501-8247
(715) 524-1554
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3200
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801087203
MI
1041C0700X
Clinical Social Worker
Primary
7848
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB087203
BCBS OF MI
MI
Enumeration date
07/12/2006
Last updated
06/24/2016
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