| Bloom Space Counseling, Pllc | |
|
315 S Peoria Ave Dixon IL 61021-2956 | |
| (815) 677-6280 | |
| Not Available |
| Full Name | Bloom Space Counseling, Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 315 S Peoria Ave, Dixon, Illinois |
| Authorized Official Name and Position | Jessica West (OWNER/OPERATOR) |
| Authorized Official Contact | 8156776280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Space Counseling, Pllc 446 River Bluff Dr Dixon IL 61021-8768 Ph: (815) 677-6280 | Bloom Space Counseling, Pllc 315 S Peoria Ave Dixon IL 61021-2956 Ph: (815) 677-6280 |
| NPI Number | 1376222984 |
|---|---|
| Provider Enumeration Date | 07/12/2023 |
| Last Update Date | 07/12/2023 |
| Certification Date | 07/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376222984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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