Provider Demographics
NPI:1851268288
Name:GATEAU, BLOSSOM ESEOGHENE
Entity type:Individual
Prefix:
First Name:BLOSSOM
Middle Name:ESEOGHENE
Last Name:GATEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KIMBERTON RD APT B15
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4108
Mailing Address - Country:US
Mailing Address - Phone:424-404-2048
Mailing Address - Fax:
Practice Address - Street 1:4000 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3149
Practice Address - Country:US
Practice Address - Phone:424-404-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL003105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist