Healthcare Provider Details

I. General information

NPI: 1336079946
Provider Name (Legal Business Name): BLOSSOMING GROWTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 NE 63RD AVE
VANCOUVER WA
98661-2499
US

IV. Provider business mailing address

5005 NE 63RD AVE
VANCOUVER WA
98661-2499
US

V. Phone/Fax

Practice location:
  • Phone: 440-413-4103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CALVEY
Title or Position: OWNER
Credential: MSW
Phone: 440-413-4103