Provider Demographics
NPI:1407030745
Name:BLOOME, JOAN (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:BLOOME
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST JOHN'S HOSPITAL PEDI REHAB
Mailing Address - Street 2:800 E. CARPENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6545
Practice Address - Street 1:ST JOHN'S HOSPITAL PEDI REHAB
Practice Address - Street 2:800 E. CARPENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:217-757-6545
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist