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General NPI Number Information
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NPI Number | 1376551242
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Entity Type | Individual
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Provider Name | DAVID JONATHAN BLEECKER PHD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 627 NORTH MORTON ST STE 202
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3750
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Country | US
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Telephone | 812-323-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 4217 EAST PENN COURT
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City | BLOOMINGTON
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State | IN
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Zip | 47408-3124
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Country | US
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Telephone | 812-332-8975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20040212
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License Number State | IN
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