Healthcare Provider Details

I. General information

NPI: 1417838665
Provider Name (Legal Business Name): BLOOM THERAPY SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 NW 27TH ST STE 410
DORAL FL
33122-1903
US

IV. Provider business mailing address

8260 NW 27TH ST STE 410
DORAL FL
33122-1903
US

V. Phone/Fax

Practice location:
  • Phone: 305-322-3548
  • Fax:
Mailing address:
  • Phone: 305-322-3548
  • 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: JENNIFER CAMACHO
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC- SLP
Phone: 305-322-3548