Individual
AMY JO BLOOMFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
RR 1 BOX 1103, FAYETTEVILLE, WV 25840-9731
(304) 237-5196
Mailing address
RR 1 BOX 1103, FAYETTEVILLE, WV 25840-9731
(304) 237-5196
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-0582
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154596000
—
WV
Enumeration date
02/07/2008
Last updated
02/07/2008
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