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General NPI Number Information
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NPI Number | 1114750114
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Entity Type | Organization
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Legal Business Name | EARLY BLOSSOMS SPEECH THERAPY
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Dates
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Enumeration Date | 08/23/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 5603 HILLVIEW WAY
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City | MISSOULA
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State | MT
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Zip | 59803-3133
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Country | US
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Telephone | 406-285-1989
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 162
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City | MISSOULA
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State | MT
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Zip | 59806-0162
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Country | US
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Telephone | 406-285-1989
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | KELSEY JEAN LYNDES GLYNN
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Credential | MS, CCC-SLP
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Telephone | 406-285-1989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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