Thea Bloom, CGC

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

License

247.000180 Issued in IL

Practice address

1950 W Polk St
FL 7 Cub 64
Chicago, IL 60612-3726

Phone

(312) 864-0333

NPI assigned

Apr 12, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1255027363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3647 N KEELER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606413014",
            "telephone_number": "773-208-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 W POLK ST",
            "address_2": "FL 7 CUB 64",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123726",
            "telephone_number": "312-864-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "THEA",
        "credential": "CGC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "IL",
            "license": "247.000180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karin Beth Bloom, MSW,LCSW
• Leah Bloom
• Lisa Robyn Bloom
• Spencer Robert Bloom, DDS
• Susan L Bloom
• Karen Waisman Bloomberg, PH.D.
• Sherra C Bloomenkranz, OT
• Bloomfield Acupuncture, PLLC
• Anna Bloomfield
• Holley Rena Bloomfield

• Genetic Counselor (M.S.) in Chicago, IL
• Providers in Chicago, IL by specialty
• Genetic Counselor (M.S.) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.