Provider Demographics
NPI:1225059744
Name:BLOOR, DIANE GWEN (APSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GWEN
Last Name:BLOOR
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:GWEN
Other - Last Name:BLOOR-BIERSACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW CAPMSW
Mailing Address - Street 1:6040 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-871-9111
Mailing Address - Fax:414-871-9121
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-871-9111
Practice Address - Fax:414-871-9121
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI240-121101Y00000X, 104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health