Individual
KIRA BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2235 CLEVELAND RD, SOUTH BEND, IN 46628-3529
(574) 647-4530
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
34009847A
IN
Other
Enumeration date
02/18/2019
Last updated
04/28/2023
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