Organization
BLOOM SPACE COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WEST LCSW (OWNER/OPERATOR)
(815) 677-6280
Entity
Organization
Contact information
Practice address
315 S PEORIA AVE, DIXON, IL 61021-2956
(815) 677-6280
Mailing address
446 RIVER BLUFF DR, DIXON, IL 61021-8768
(815) 677-6280
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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