Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Stanley Wayne Blom, PHD

Individual provider Clinical Psychologist · NPI 1538119912

Dr. Stanley Wayne Blom, PHD is a Clinical Psychologist in South Bend, Indiana. Practices as a sole proprietor. Licensed in Indiana.

Licensed in
IN
In the registry since
2006
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

150 W Angela Blvd
South Bend, IN 46617-1101
Phone: (574) 251-1286
Fax: (574) 232-5386
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 20040666A (IN)

Record details

NPI number1538119912
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedMay 10, 2006
Last updated in NPPESAugust 12, 2019
Mailing address150 W Angela Blvd, South Bend, IN 46617-1101

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