JAKE B BLOOM

MENOMONIE, WI
NPI1730712308
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: WI  4058-125)
Enumeration Date2020-02-21
Last Update Date2020-12-02
Business Address
JAKE B BLOOM LPC
4076 KOTHLOW AVE
MENOMONIE, WI 54751-3090
Phone number: 715-235-4537
Mailing Address
JAKE B BLOOM LPC
803 BALLENTINE RD
MENOMONIE, WI 54751-3740
Phone number: 715-505-0101
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