Individual
JAKE B BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4076 KOTHLOW AVE, MENOMONIE, WI 54751-3090
(715) 235-4537
(715) 235-4535
Mailing address
803 BALLENTINE RD, MENOMONIE, WI 54751-3740
(715) 505-0101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4058-125
WI
Other
Enumeration date
02/21/2020
Last updated
12/02/2020
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