Provider Demographics
NPI:1184595951
Name:BLOM, LAURA (ASW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BLOM
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0811
Mailing Address - Country:US
Mailing Address - Phone:209-576-2283
Mailing Address - Fax:
Practice Address - Street 1:5901 SISK RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8870
Practice Address - Country:US
Practice Address - Phone:209-545-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW107006104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker