Provider Demographics
NPI:1174241665
Name:BLOOMQUIST, EMILY (BS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3524
Mailing Address - Country:US
Mailing Address - Phone:402-840-1089
Mailing Address - Fax:
Practice Address - Street 1:201 E 33RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3524
Practice Address - Country:US
Practice Address - Phone:712-833-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist