STANLEY WAYNE BLOM Clinical Psychologist License verification

Business Entity

INACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071005352

License Status

INACTIVE

Business

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

City

SOUTH BEND

State

Zip

46615

County

INDIANA

Ever Disciplined

LastModifiedDate

07/10/2008