KATHLEEN BLOOM
NPI 1952794950
Counselor - Professional in Grand Rapids, MI
Active since March 15, 2015
About Kathleen Bloom NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KATHLEEN BLOOM (NPI 1952794950) is an individual professional provider in Grand Rapids, Michigan, licensed in Michigan (6401001493) and active in the NPI registry since March 2015.
NPPES Registry Identity
NPI1952794950
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameKATHLEEN BLOOM
Location Address1558 PINE AVE NWGrand Rapids, MI 49504-3029
Mailing Address1558 Pine Ave NwGrand Rapids, MI 49504-3029 · (616) 901-2777 · Fax (616) 336-4333
Phone(616) 901-2777
Fax(616) 336-4333
Sole ProprietorYes
Enumeration DateMarch 15, 2015
✔ NPI 1952794950 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MI · 6401001493
1558 PINE AVE NW, Grand Rapids, MI 49504
Other Identifiers 1
Medicaid101YO2500XMI
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1952794950, enumerated as an "individual" on March 15, 2015.
The provider is located at 1558 PINE AVE NW GRAND RAPIDS, MI 49504 and the phone number is (616) 901-2777.
Counselor with taxonomy code 101YP2500X and a focus in Professional.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
