Provider Demographics
NPI:1093546954
Name:BLOOM SPEECH & LANGUAGE THERAPY LLC
Entity type:Organization
Organization Name:BLOOM SPEECH & LANGUAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-659-2076
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:TX
Mailing Address - Zip Code:77629-0310
Mailing Address - Country:US
Mailing Address - Phone:409-659-2076
Mailing Address - Fax:
Practice Address - Street 1:115 HIGHWAY 326 S
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659-7871
Practice Address - Country:US
Practice Address - Phone:409-659-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty