Provider Demographics
NPI:1124303086
Name:LIL' BLOOMERS SPEECH THERAPY CLINIC
Entity type:Organization
Organization Name:LIL' BLOOMERS SPEECH THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:888-545-2566
Mailing Address - Street 1:337 S BEVERLY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4315
Mailing Address - Country:US
Mailing Address - Phone:888-545-2566
Mailing Address - Fax:888-545-2566
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:888-545-2566
Practice Address - Fax:888-545-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15011252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency