Individual
DR. SUSAN DOROTHY BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
905 FOREST AVE E, SUITE 150, MORA, MN 55051-1624
(320) 679-6346
(320) 679-6351
Mailing address
825 ASHLAND ST S, CAMBRIDGE, MN 55008-2110
(763) 689-5250
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1194
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114047
U CARE
MN
01
—
52096BL
BLUE CROSS BLUE SHIELD
MN
01
—
61-21928
MEDICA
MN
01
—
72233-1010048
PREFERRED ONE
MN
Enumeration date
11/12/2006
Last updated
07/08/2007
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