Dr. Bernhard Emile Blom, Ph.D.
Psychologist, Clinical in North Chicago, IL. Individual provider (NPI-1).
NPI number1811910656
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1811910656
- Entity type
- Individual (NPI-1)
- Name
- Dr. Bernhard Emile Blom
- Credential
- Ph.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 25, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 071001963 | IL | Yes |
Practice location
3001 Green Bay RdPsychology Service, Va Medical Center (116b)
North Chicago, IL 60064
Phone 224-610-3234 · Fax 224-610-3869
Mailing address
725 N Midlothian RdMundelein, IL 60060-1255
Phone 224-610-3234 · Fax 224-610-3869
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