Doctor Name: | MRS. JESSICA ANN BLOOM |
NPI Number: | 1174702583 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | B45042183855 |
Business Practice Address: | 5617 W Von Ave Unit C Monee, IL - 604497917 |
Business Phone Number: | 8159534023 |
Business Fax Number: | 7085347715 |
Mailing Address: | 5617 Von Ave Unit C, MONEE |
State: | IL |
Postal Code: | 604496044 |
Phone Number: | 8159534023 |
Fax Number: | 7085347715 |
NPI Enumeration Date: | 11/01/2007 |
NPI Last Update Date: | 11/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | B45042183855 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |