JACOB BLOOM (NPI# 1730712308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730712308 |
| Entity Type | Individual |
| Full Name | JACOB BLOOM |
| Credential | LPC |
| Practice Address |
4076 Kothlow Ave Menomonie WI 54751-3090 |
| Mailing Address |
803 Ballentine Rd Menomonie WI 54751-3740 |
| Practice Telephone | 7152354537 |
| Practice Fax Number | 7152354535 |
| Mailing Telephone | 7155050101 |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
4058-125 | WI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770757130 | Jacob Maxwell-phillip Bloom | Plastic Surgery | 1 E Delaware Pl Ste 501, Chicago, IL 60611 | 2008-04-16 |
| 1760942494 | Jacob Cameron Bloom | Student in an Organized Health Care Education/Training Program | 830 Harrison Ave Fl 1, Boston, MA 02118-2905 | 2019-03-20 |
| Street Address |
4076 KOTHLOW AVE |
| City | MENOMONIE |
| State | WI |
| Zip Code | 54751-3090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598899353 | Arbor Place, Inc. | Clinic/Center | 4076 Kothlow Ave, Menomonie, WI 54751 | 2007-03-15 |
| 1720625049 | Tara L Thiele | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2019-12-05 |
| 1649820168 | Elyse Henke | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2019-09-17 |
| 1396397337 | Stephanie Hurlburt | Social Worker | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2019-07-10 |
| 1801395033 | Joshua Paul Bleskachek | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2018-02-02 |
| 1871013458 | Mackenzie Ann Deffenbaugh | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2017-06-23 |
| 1013458173 | Arbor Place, Inc. | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2017-03-09 |
| 1497889026 | Arbor Place, Inc. | Clinic/Center | 4076 Kothlow Ave, Menomonie, WI 54751 | 2007-03-15 |
| 1073647665 | Arbor Place, Inc. | Substance Abuse Rehabilitation Facility | 4076 Kothlow Ave, Menomonie, WI 54751 | 2007-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154840569 | Ashley Friedenfels | Physical Medicine & Rehabilitation | E4486 290th Avenue, Menomonie, WI 54751 | 2017-09-18 |
| 1215307814 | David Calvin Reimann | Hearing Instrument Specialist | E4584 483rd Avenue, Menomonie, WI 54751 | 2015-09-25 |
| 1790128627 | County of Dunn | Skilled Nursing Facility | 651 Howison Circle, Menominie, WI 54751 | 2013-04-10 |
| 1043653983 | County of Dunn | Skilled Nursing Facility | 658 Howison Circle, Menomonie, WI 54751 | 2013-04-10 |
| 1447519236 | Gentle Dental Care LLC | Dentist | 1813 Wilson St., Menomonie, WI 54751 | 2012-05-14 |
| 1386960193 | Kilimanjaro LLC | Non-emergency Medical Transport (VAN) | 1222 14th Ave E, Menomonie, WI 54751 | 2010-04-19 |
| 1275709180 | Dianne Marie Bennett | Counselor | 1916 2nd St W, Menomonie, WI 54751 | 2008-05-01 |
| 1417136201 | David Gary Hackbarth | Chiropractor | 3120 Schneider Ave E, Suite #5, Menomonie, WI 54751 | 2007-10-29 |
| 1306057336 | Tonia D. Behling | Dental Hygienist | 3375 Kothlow Ave., Suite 40, Menomonie, WI 54751 | 2007-05-24 |
| 1295956282 | Danny Roger Wood | Dentist | 1603 Stout Rd, Menomonie, WI 54751 | 2007-05-01 |
| Find all providers in zip 54751 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467755454 | Rebecca D Smith | Counselor | 700 Wolske Bay Rd Ste 140, Menomonie, WI 54751-1679 | 2010-12-13 |
| 1588667406 | County of Dunn | Counselor | 3001 Us Highway 12 East, Suite 160, Menomonie, WI 54751-3045 | 2005-05-24 |
| 1629683271 | Stacy Ann Plumer | Counselor | 3001 Us Highway 12 E Ste 160, Menomonie, WI 54751-3045 | 2020-09-10 |
| 1649820168 | Elyse Henke | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2019-09-17 |
| 1174012694 | Gabrielle Margaret Albers | Counselor | 402 Technology Dr E, Menomonie, WI 54751-2370 | 2018-05-10 |
| 1942708177 | Jenna Hennessey | Counselor | 402 Technology Dr E, Menomonie, WI 54751-2370 | 2018-01-23 |
| 1871013458 | Mackenzie Ann Deffenbaugh | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2017-06-23 |
| 1013458173 | Arbor Place, Inc. | Counselor | 4076 Kothlow Ave, Menomonie, WI 54751-3090 | 2017-03-09 |
| 1477834620 | Barbara Ann Deutscher | Counselor | 320 21st St N, Menomonie, WI 54751-2228 | 2011-09-01 |
| 1346545506 | Greer Gust | Counselor | 3001 Us Highway 12 East, Suite 160, Menomonie, WI 54751-3045 | 2011-01-20 |
| Find all providers in MENOMONIE | ||||
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| 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.