Healthcare Provider Details

I. General information

NPI: 1639767221
Provider Name (Legal Business Name): BLOSSOM SPEECH & LANGUAGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8177 GLADES RD STE 202
BOCA RATON FL
33434-4022
US

IV. Provider business mailing address

5469 HELENE CIR
BOYNTON BEACH FL
33472-1241
US

V. Phone/Fax

Practice location:
  • Phone: 561-270-4433
  • Fax:
Mailing address:
  • Phone: 954-821-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MALLORY LYNN BOYD
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 954-821-9215