Provider Demographics
NPI:1669682977
Name:BLOOM, AMY JO (AUD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:BLOOM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4603
Mailing Address - Country:US
Mailing Address - Phone:325-793-3400
Mailing Address - Fax:325-793-3587
Practice Address - Street 1:3001 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5129
Practice Address - Country:US
Practice Address - Phone:325-223-6300
Practice Address - Fax:325-793-3587
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80054231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist