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Dr. Stanley Wayne Blom, PHD
Clinical Psychologist in South Bend, Indiana
NPI 1538119912

Stanley Wayne Blom is a Clinical Psychologist based in South Bend, IN and is specialized in Clinical. Stanley Wayne Blom practices in South Bend, IN and has the professional credentials of PHD. The NPI Number for Stanley Wayne Blom is 1538119912 and holds a License No. 20040666A (Indiana).

The current practice location address for Stanley Wayne Blom is 150 W Angela Blvd, South Bend, IN and can be reached out via phone at 574-251-1286 and via fax at 574-232-5386. You can also correspond with Stanley Wayne Blom through the mailing address at 150 W ANGELA BLVD, SOUTH BEND, IN - 46617-1101 (mailing address contact number: 574-251-1286).

Location: 150 W Angela Blvd, South Bend, IN, 46617-1101
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1538119912
Provider Name
Stanley Wayne Blom
Credential
PHD
Provider Entity Type
Individual
Gender
Male
Address
150 W Angela Blvd, South Bend, IN, 46617-1101
Phone Number
574-251-1286
Fax Number
574-232-5386
Provider Enumeration Date
05/10/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200008720 05 IN
institution
Provider Business Practice Location Address Details
Address
150 W Angela Blvd
City
South Bend
State
Indiana
Zip
46617-1101
Phone Number
574-251-1286
Fax Number
574-232-5386
person
Provider Business Mailing Address Details
Address
150 W Angela Blvd
City
South Bend
State
Indiana
Zip
46617-1101
Phone Number
574-251-1286
Fax Number
574-232-5386
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Clinical
Taxonomy
103TC0700X
License No.
20040666A (Indiana)
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
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