Provider Demographics
NPI:1861220246
Name:BLOOM THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:BLOOM THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN-NIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:984-332-9888
Mailing Address - Street 1:1209 COTTON ARBOR TRCE
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7412
Mailing Address - Country:US
Mailing Address - Phone:984-332-9988
Mailing Address - Fax:
Practice Address - Street 1:1209 COTTON ARBOR TRCE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7412
Practice Address - Country:US
Practice Address - Phone:984-332-9988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty