Individual provider Active NPI

Marie Bloem, M.A., CF-SLP

  • Speech-Language Assistant
  • Chicago, IL
National Provider Identifier
1376901207
Registry record updated Feb 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
242.003829 Issued in IL
Practice address
1957 W Dickens Ave
Chicago, IL 60614-3934
Phone
(773) 698-6535
NPI assigned
Feb 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X 242.003829 IL Primary

Addresses

Primary practice location

1957 W Dickens Ave
Chicago, IL 60614-3934

Mailing address

1957 W Dickens Ave
Chicago, IL 60614-3934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
242.003829ILMDSpeech-Language Assistant

NPI Registry JSON

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

{
    "created_epoch": "1454716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454716800000",
    "number": "1376901207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 W DICKENS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 W DICKENS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143934",
            "telephone_number": "773-698-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOEM",
        "first_name": "MARIE",
        "credential": "M.A., CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-06",
        "last_updated": "2016-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "IL",
            "license": "242.003829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2016; 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.