Provider Demographics
NPI:1811594658
Name:GOELLER-BLOOM, KAAREN
Entity Type:Individual
Prefix:MS
First Name:KAAREN
Middle Name:
Last Name:GOELLER-BLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAAREN
Other - Middle Name:
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:106 WEST MISSION
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:509-473-4810
Mailing Address - Fax:
Practice Address - Street 1:106 WEST MISSION
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-473-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health