Kieren Charles Blom

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

32650 State Route 20 Ste E204
Oak Harbor, WA 98277-2686

Phone

(208) 996-2811

NPI assigned

Oct 16, 2024

Last updated

Nov 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1811717408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32650 STATE ROUTE 20 STE E204",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982772686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32650 STATE ROUTE 20 STE E204",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982772686",
            "telephone_number": "208-996-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOM",
        "first_name": "KIEREN",
        "middle_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Reese J Bliek, P.A.
• Blue Water Behavioral Consulting LLC
• Lauren Elizabeth Bock, PA-C
• Brandon Boelter
• Howard A. Bolton
• Charles Anson Bond, MSW

• Behavior Technician in Oak Harbor, WA
• Providers in Oak Harbor, WA by specialty
• Behavior Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.