Provider Demographics
NPI:1417000639
Name:BLOOMBERG, JOANN E (MSED, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:E
Last Name:BLOOMBERG
Suffix:
Gender:F
Credentials:MSED, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2965
Mailing Address - Country:US
Mailing Address - Phone:309-836-6494
Mailing Address - Fax:309-836-6494
Practice Address - Street 1:701 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2965
Practice Address - Country:US
Practice Address - Phone:309-836-6494
Practice Address - Fax:309-836-6494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional