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General NPI Number Information
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NPI Number | 1770490534
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Entity Type | Organization
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Legal Business Name | BLOOM CHILD PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 113 N MAIN ST
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City | MORTON
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State | IL
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Zip | 61550-2051
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Country | US
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Telephone | 309-241-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 14 HAWTHORN CV
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City | MORTON
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State | IL
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Zip | 61550-9695
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Country | US
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Telephone | 309-741-2411
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | JESSICA MCKINLEY-SIMPSON
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Credential | PHD, NCSP
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Telephone | 815-343-0678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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