DR. STANLEY WAYNE BLOM (NPI# 1538119912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538119912 |
| Entity Type | Individual |
| Full Name | DR. STANLEY WAYNE BLOM |
| Other Name | STAN BLOM, PH.D., INC |
| Credential | PH.D. |
| Practice Address |
150 W Angela Blvd South Bend IN 46617-1101 |
| Practice Telephone | 5742511286 |
| Practice Fax Number | 5742325386 |
| Mailing Telephone | 5742511286 |
| Mailing Fax Number | 5742325386 |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-08-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20040666A | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200008720 | 05 |
| Street Address |
150 W ANGELA BLVD |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-1101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245237114 | Gwendolyn C Dehorn | Counselor | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2005-07-07 |
| 1730463001 | Barbara Finley, Lcsw/m.div,. LLC | Social Worker | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2011-10-05 |
| 1760613681 | Lisa J Dulcet | Counselor | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2009-07-28 |
| 1720250756 | Advanced Medical Computing Inc | Counselor | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2008-03-31 |
| 1356520977 | Timothy A. Onkka, Ph.d., P.C. | Psychologist | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2007-10-31 |
| 1548454390 | Jamie Rexine Price | Counselor | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2007-09-04 |
| 1063570331 | James Robert Wittling | Counselor | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2006-12-05 |
| 1033298880 | James P Schalliol I | Psychiatry & Neurology | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2006-11-03 |
| 1891882510 | Timothy Allan Onkka | Psychologist | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2006-10-06 |
| 1871512939 | Francis G Samora | Social Worker | 150 W Angela Blvd, South Bend, IN 46617-1101 | 2006-07-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346697000 | Alexandra Filia Corning | Psychologist | 1251 N. Eddy Street, Suite 200, South Bend, IN 46530-6258 | 2016-05-23 |
| 1629222088 | Suzanne Courtney | Psychologist | 129 Franklin Pl, South Bend, IN 46601-1543 | 2008-11-12 |
| 1518111996 | Jacqueline Mary Quinn-tan | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2008-11-11 |
| 1942487483 | David A Smith | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2008-01-28 |
| 1972727949 | Susan Steibe-pasalich | Psychologist | 201 N Ironwood Dr, South Bend, IN 46615-2517 | 2007-04-12 |
| 1952452534 | Diane Johnson Prosser | Psychologist | 227 N Dixie Way Ste 110, South Bend, IN 46637-3366 | 2007-01-12 |
| 1053476697 | Barbara S Searle | Psychologist | 3603 E Jefferson Blvd, Suiteb, South Bend, IN 46615-3035 | 2006-12-26 |
| 1629144043 | Michael Owen Reed | Psychologist | 220 W Colfax Ave, Ste 400, South Bend, IN 46601-1635 | 2006-11-28 |
| 1902984958 | James F Brogle | Psychologist | 828 E Colfax Ave, South Bend, IN 46617-2804 | 2006-11-01 |
| 1518055565 | Michael Robert Sheehan | Psychologist | 1230 Hillcrest Rd, South Bend, IN 46617-1169 | 2006-10-11 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
Please comment or provide details below to improve the information on DR. STANLEY WAYNE BLOM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.