Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I9849 | OH |
NPI | 1003146853 |
---|---|
Provider Name | Ms. Ada M Bloom |
First Address | Sandusky, OH 44870-4737 |
Second Address | Sandusky, OH 44870-4737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2009 |
Last Update Date | 29/12/2009 |