Individual
JAIMEE BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPE, LE
Contact information
Practice address
1017 SW MORRISON ST STE 400, PORTLAND, OR 97205-2629
(503) 224-3300
Mailing address
1017 SW MORRISON ST STE 400, PORTLAND, OR 97205-2629
(503) 224-3300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10152387
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386009959
NPI
—
Enumeration date
12/23/2015
Last updated
12/31/2015
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