Individual
AMANDA L BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
1807 SMITH ST, LOGANSPORT, IN 46947-1576
(574) 732-1414
(574) 732-0504
Mailing address
1807 SMITH ST, LOGANSPORT, IN 46947-1576
(574) 732-1414
(574) 732-0504
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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