Provider Demographics
NPI:1427761824
Name:BLOOM, DYLAN GABRIEL (BSW, MSW INTERN)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:GABRIEL
Last Name:BLOOM
Suffix:
Gender:M
Credentials:BSW, MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15724 S ROUTE 59 STE 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2806
Mailing Address - Country:US
Mailing Address - Phone:630-527-8877
Mailing Address - Fax:630-527-8877
Practice Address - Street 1:15724 S ROUTE 59 STE 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2806
Practice Address - Country:US
Practice Address - Phone:630-527-8877
Practice Address - Fax:630-527-8877
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker