Bloom, Georgette

Bloom, Georgette is an individual health care provider with primary practice located at 3010 Grand Ave Floor 1, Waukegan IL 60085-2321. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Bloom, Georgette can be contacted via phone (847) 377-8180.

Contact Information

Primary practice address
3010 Grand Ave Floor 1 Waukegan IL 60085-2321
Phone: (847) 377-8180
Fax: (847) 984-5682
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 180.001111 Illinois

Profile Details

NPI number 1528088895
LBN Legal business name Bloom, Georgette
Credentials CPC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2006
Last updated Aug 28th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528088895 NPPES
Illinois MEDICAID 180001111

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