DR. SUSAN DOROTHY BLOM PH.D.
NPI 1700957842
Psychologist in Mora, MN

Active since November 12, 2006PECOS Enrolled
905 FOREST AVE E, SUITE 150, MORA, MN 55051(320) 679-6346(320) 679-6351 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Susan Dorothy Blom Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SUSAN DOROTHY BLOM PH.D. (NPI 1700957842) is an individual psychologist in Mora, Minnesota, licensed in Minnesota (LP1194) and active in the NPI registry since November 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1982).

NPPES Registry Identity

NPI1700957842
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. SUSAN DOROTHY BLOMCredential: PH.D.
Location Address905 FOREST AVE E, SUITE 150Mora, MN 55051-1624
Mailing Address825 Ashland St SCambridge, MN 55008-2110 · (763) 689-5250
Fax(320) 679-6351
Sole ProprietorYes
Medical School CMSOtherGraduated 1982
Enumeration DateNovember 12, 2006
Last NPPES UpdateJuly 8, 2007
NPI 1700957842 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in MN · LP1194
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
905 FOREST AVE E, Mora, MN 55051

Other Identifiers 4

Other52096BLMN · Blue Cross Blue Shield
Other72233-1010048MN · Preferred One
Other61-21928MN · Medica
Other114047MN · U Care

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Susan Dorothy Blom Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1850339003
PECOS Enrollment IDI20050419001153
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Public Health or Welfare
905 FOREST AVE E, STE 127
MORA, MN 55051
Case Management
905 FOREST AVE E, SUITE 150
MORA, MN 55051
Nurse Practitioner (Psychiatric/Mental Health)
905 FOREST AVE E
MORA, MN 55051
Public Health or Welfare
905 FOREST AVE E, SUITE 127
MORA, MN 55051
Psychologist (Counseling)
905 FOREST AVE E, STE 150
MORA, MN 55051
Public Health or Welfare
905 FOREST AVE E, SUITE 127
MORA, MN 55051
Public Health or Welfare
905 FOREST AVE E, STE. 127
MORA, MN 55051
Community/Behavioral Health
905 FOREST AVE E, SUITE 150
MORA, MN 55051

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Blom's NPI number?

The NPI number for Susan Blom is 1700957842. It was assigned to this individual provider in the NPPES registry on November 12, 2006.

Where is Susan Blom located?

Susan Blom practices at 905 Forest Ave E Suite 150, Mora, MN 55051. The listed phone number is (320) 679-6346.

What is Susan Blom's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Susan Blom enrolled in Medicare?

Yes. Susan Blom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Susan Blom was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.