STANLEY WAYNE BLOM - Clinical Psychologist License in Indiana | # 071005352

STANLEY WAYNE BLOM

Business Entity

INACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071005352

License Status

INACTIVE

Business

N

First Name

STANLEY WAYNE

Last Name

BLOM

Business Name

STANLEY WAYNE BLOM

Original Issue Date

12/26/1996

Effective Date

07/13/2006

Expiration Date

09/30/2008

State

IN

Ever Disciplined

N

LastModifiedDate

07/10/2008