Provider Demographics
NPI:1699481390
Name:BLOOM THERAPY GROUP LLC
Entity type:Organization
Organization Name:BLOOM THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:321-945-5446
Mailing Address - Street 1:3436 MAGAZINE ST # 8006
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2480
Mailing Address - Country:US
Mailing Address - Phone:504-356-2025
Mailing Address - Fax:
Practice Address - Street 1:3436 MAGAZINE ST # 8006
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2480
Practice Address - Country:US
Practice Address - Phone:504-356-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty