Basic Information
| Provider Information | |||||||||
| NPI: | 1649520925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOOM | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 15TH ST SW | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980205168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256724637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6220 SOUTH ALASKA STREET | ||||||||
| Address2: | ALASKA GARDENS | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534765300 | ||||||||
| FaxNumber: | 2534765365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 09/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 60120522 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.