Provider Demographics
NPI:1710439369
Name:BLUM, HAYLEY (MSW)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 TAFT AVE
Mailing Address - Street 2:202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1575
Mailing Address - Country:US
Mailing Address - Phone:847-962-2383
Mailing Address - Fax:
Practice Address - Street 1:5606 TAFT AVE
Practice Address - Street 2:202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1575
Practice Address - Country:US
Practice Address - Phone:847-962-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW74332390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program