Healthcare Provider Details

I. General information

NPI: 1598446544
Provider Name (Legal Business Name): KATIE MAE TWILA BLOOM PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12948 CHANDLER ST
OMAHA NE
68138-6016
US

IV. Provider business mailing address

12948 CHANDLER ST
OMAHA NE
68138-6016
US

V. Phone/Fax

Practice location:
  • Phone: 402-604-1063
  • Fax:
Mailing address:
  • Phone: 402-604-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13450
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: