Blom, Stanley Wayne
Blom, Stanley Wayne is an sole proprietor health care provider with primary practice located at 150 W Angela Blvd , South Bend IN 46617-1101. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Blom, Stanley Wayne can be contacted via phone (574) 251-1286.Contact Information
Primary practice address
150 W Angela Blvd
South Bend IN 46617-1101
Phone: (574) 251-1286
Fax: (574) 232-5386
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20040666A | Indiana |
Profile Details
| NPI number | 1538119912 |
|---|---|
| LBN Legal business name | Blom, Stanley Wayne |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 10th, 2006 |
| Last updated | Aug 12th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538119912 | NPPES |
| Indiana | MEDICAID | 200008720 |
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