Provider Demographics
NPI:1356859466
Name:BLOOM, LAURA LEE (NMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 NE 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-4213
Mailing Address - Country:US
Mailing Address - Phone:602-501-5491
Mailing Address - Fax:833-992-2066
Practice Address - Street 1:1404 NE 134TH ST STE 180C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2799
Practice Address - Country:US
Practice Address - Phone:360-450-5778
Practice Address - Fax:833-992-2065
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1681175F00000X
OR4397175L00000X
WA61015964175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath