Provider Demographics
NPI:1316716814
Name:BLOOMBURG, CAROLYN (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BLOOMBURG
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 S WINTER ST APT E21
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8760
Mailing Address - Country:US
Mailing Address - Phone:906-284-9364
Mailing Address - Fax:
Practice Address - Street 1:1424 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4309
Practice Address - Country:US
Practice Address - Phone:517-312-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152000797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist