Individual
INGRID A BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
12 S 6TH ST, #1137, MINNEAPOLIS, MN 55402
(612) 722-7414
Mailing address
3637 46TH AVE S, MINNEAPOLIS, MN 55406
(612) 722-7414
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
01806
MN
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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