Individual
ILENE LINDA BLOOM-ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, ACSW
Contact information
Practice address
6815 LEONA ST, SAINT LOUIS, MO 63116-2833
(314) 703-0062
Mailing address
6815 LEONA ST, SAINT LOUIS, MO 63116-2833
(314) 703-0062
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004460
MO
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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