BERNHARD E BLOM PHD Clinical Psychologist License verification

Business Entity

CANCELLED

License Type

Clinical Psychologist

Description

REGISTERED PSYCHOLOGIST

License Number

072001963

License Status

CANCELLED

Business

First Name

BERNHARD

Middle

Last Name

BLOM

Suffix

PHD

Business Name

BERNHARD E BLOM PHD

Original Issue Date

01/29/1976

Expiration Date

09/30/1990

City

WAUKEGAN

State

Zip

60087

County

LAKE

Ever Disciplined

LastModifiedDate

09/04/2005