Healthcare Provider Details

I. General information

NPI: 1396558920
Provider Name (Legal Business Name): AWAKEN AND BLOOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E 3900 S STE 102
SALT LAKE CITY UT
84124-4402
US

IV. Provider business mailing address

356 E SAUNDERS ST
SALT LAKE CITY UT
84107-6015
US

V. Phone/Fax

Practice location:
  • Phone: 385-279-2410
  • Fax:
Mailing address:
  • Phone: 801-657-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER SEAY
Title or Position: OWNER
Credential: LAC
Phone: 801-657-1476