Individual
GEORGETTE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPC
Contact information
Practice address
3010 GRAND AVE, FLOOR 1, WAUKEGAN, IL 60085-2321
(847) 377-8180
(847) 984-5682
Mailing address
3010 GRAND AVE, FLOOR 1, WAUKEGAN, IL 60085-2321
(847) 377-8180
(847) 984-5682
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.001111
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180001111
—
IL
Enumeration date
07/20/2006
Last updated
08/28/2012
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