Provider Demographics
NPI:1407241409
Name:BLOOMINGDALE, NORA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:L
Last Name:BLOOMINGDALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16706 30TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:847-217-4191
Practice Address - Street 1:4216 122ND PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9100
Practice Address - Country:US
Practice Address - Phone:425-475-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60562634101YM0800X
WAPY60674062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health