Provider Demographics
NPI:1720476930
Name:BLOOM, KENDRA (LMFTA, MA)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMFTA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 16TH AVE E
Mailing Address - Street 2:202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5143
Mailing Address - Country:US
Mailing Address - Phone:925-330-2548
Mailing Address - Fax:
Practice Address - Street 1:349 16TH AVE E
Practice Address - Street 2:202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5143
Practice Address - Country:US
Practice Address - Phone:925-330-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60523406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health