Healthcare Provider Details

I. General information

NPI: 1770490534
Provider Name (Legal Business Name): BLOOM CHILD PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N MAIN ST
MORTON IL
61550-2051
US

IV. Provider business mailing address

14 HAWTHORN CV
MORTON IL
61550-9695
US

V. Phone/Fax

Practice location:
  • Phone: 309-241-7411
  • Fax:
Mailing address:
  • Phone: 309-741-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MCKINLEY-SIMPSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD, NCSP
Phone: 815-343-0678