Provider Demographics
NPI:1386009959
Name:BLOOM, JAIMEE (CPE, LE)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:CPE, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SW MORRISON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2629
Mailing Address - Country:US
Mailing Address - Phone:503-224-3300
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2629
Practice Address - Country:US
Practice Address - Phone:503-224-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10152387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386009959OtherNPI