Healthcare Provider Details

I. General information

NPI: 1295651461
Provider Name (Legal Business Name): MOLLY BLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 FRANKLIN SQUARE DR
ROSEDALE MD
21237-4458
US

IV. Provider business mailing address

1812 REUTER RD
LUTHERVILLE MD
21093-5220
US

V. Phone/Fax

Practice location:
  • Phone: 410-391-2600
  • 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 StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: