Provider Demographics
NPI:1417838665
Name:BLOOM THERAPY SERVICES LLC.
Entity type:Organization
Organization Name:BLOOM THERAPY SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC- SLP
Authorized Official - Phone:305-322-3548
Mailing Address - Street 1:9725 HAMMOCKS BLVD APT 104F
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1529
Mailing Address - Country:US
Mailing Address - Phone:305-322-3548
Mailing Address - Fax:
Practice Address - Street 1:9725 HAMMOCKS BLVD APT 104F
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1529
Practice Address - Country:US
Practice Address - Phone:305-322-3548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty