Provider Demographics
NPI:1649520925
Name:BLOOM, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 15TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5168
Mailing Address - Country:US
Mailing Address - Phone:425-672-4637
Mailing Address - Fax:
Practice Address - Street 1:6220 SOUTH ALASKA STREET
Practice Address - Street 2:ALASKA GARDENS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1317
Practice Address - Country:US
Practice Address - Phone:253-476-5300
Practice Address - Fax:253-476-5365
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60120522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist