Provider Demographics
NPI:1942058748
Name:BLOOD, MADELINE LOU (PLPC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LOU
Last Name:BLOOD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:HUELSKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:1003 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-1429
Mailing Address - Country:US
Mailing Address - Phone:888-924-3786
Mailing Address - Fax:
Practice Address - Street 1:102 4TH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5043
Practice Address - Country:US
Practice Address - Phone:618-877-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024015661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health