Doctor Name: | MR. KENNETH A. BLOYD |
NPI Number: | 1295912343 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W. |
License Number: | 149010507 |
Business Practice Address: | 615 N Promenade St Havana, IL - 626441243 |
Business Phone Number: | 3095434431 |
Business Fax Number: | 3095438122 |
Mailing Address: | 615 N Promenade St, HAVANA |
State: | IL |
Postal Code: | 626441243 |
Phone Number: | 3095434431 |
Fax Number: | 3095438122 |
NPI Enumeration Date: | 01/30/2008 |
NPI Last Update Date: | 11/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149010507 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |