Kendra Sundin Bloom, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

20258150925 Issued in MI

Practice address

1229 W. Washington St. Suite 5
Marquette, MI 49855-0000

Phone

(906) 273-1121

Fax

(906) 225-6706

NPI assigned

Jul 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Functional Behavior Services, LLC

  • Behavior Analyst
  • Marquette, MI
  • NPI 1780044404
  NPD

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1609484898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 W. WASHINGTON ST. SUITE 5",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498550000",
            "telephone_number": "906-273-1121",
            "fax_number": "906-225-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 W. WASHINGTON ST. SUITE 5",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498550000",
            "telephone_number": "906-273-1121",
            "fax_number": "906-225-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "KENDRA",
        "middle_name": "SUNDIN",
        "name_prefix": "Ms.",
        "credential": "BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "MI",
            "license": "20045130244",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "20258150925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MARQUETTE",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1229 W Washington St Ste 5",
            "city": "Marquette",
            "state": "MI",
            "country_code": "US",
            "postal_code": "498553186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole L Blaauw, PA-C
• Janet Lynn Blake
• Carol Blashill, RN
• Kyle Edward Blau, DDS
• Jennifer Lynne Bleckiner, CCC/SLP-L
• Robert Howells Blotter, MD
• Stephanie Blubaugh, LCSW
• Cassie Bluhm, DO
• Holly Ann Boburka, MS A.T.,C.
• Body Mechanix Physical Therapy of Marquette, LLC

• Behavior Analyst in Marquette, MI
• Providers in Marquette, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.