Healthcare Provider Details

I. General information

NPI: 1144011941
Provider Name (Legal Business Name): BUMBLE BEE PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 IRENE ST
KIMBERLY ID
83341-2047
US

IV. Provider business mailing address

730 IRENE ST
KIMBERLY ID
83341-2047
US

V. Phone/Fax

Practice location:
  • Phone: 208-420-8623
  • Fax:
Mailing address:
  • Phone:
  • 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: BROOKE BERTRAND
Title or Position: OWNER
Credential:
Phone: 208-420-8623