Provider Demographics
NPI:1104869346
Name:BLOOD, DIONNE MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:MARIE
Last Name:BLOOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SELBY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4528
Mailing Address - Country:US
Mailing Address - Phone:612-655-7678
Mailing Address - Fax:
Practice Address - Street 1:1595 SELBY AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4528
Practice Address - Country:US
Practice Address - Phone:612-655-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN164751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical