Provider Demographics
NPI:1598446544
Name:BLOOM, KATIE MAE TWILA (PLMHP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MAE TWILA
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FLETCHER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-5862
Mailing Address - Country:US
Mailing Address - Phone:402-604-1063
Mailing Address - Fax:
Practice Address - Street 1:2100 FLETCHER AVE STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-5862
Practice Address - Country:US
Practice Address - Phone:402-604-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE134501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical