Individual
LYNN MARIE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
5905 GOLDEN VALLEY RD, SUITE 100, GOLDEN VALLEY, MN 55422-4463
(763) 225-4052
(888) 965-5130
Mailing address
5905 GOLDEN VALLEY RD, SUITE 100, GOLDEN VALLEY, MN 55422-4463
(763) 225-4052
(888) 965-5130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302028
MN
1041C0700X
Clinical Social Worker
Primary
14996
MN
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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