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Individual
BRYAN ALLEN BLOEMENDAAL
Active
Individual
BRYAN ALLEN BLOEMENDAAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1797
ND
101YA0400X
Addiction (Substance Use Disorder) Counselor
304586
MN
Other
Enumeration date
08/09/2016
Last updated
08/29/2016
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