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General NPI Number Information
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NPI Number | 1124303086
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Entity Type | Organization
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Legal Business Name | LIL' BLOOMERS SPEECH THERAPY CLINIC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 337 S BEVERLY DR SUITE 107
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-4315
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Country | US
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Telephone | 888-545-2566
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Fax | 888-545-2566
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Provider Business Mailing Address
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Address Line | 337 S BEVERLY DR SUITE 107
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-4315
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Country | US
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Telephone | 888-545-2566
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Fax | 888-545-2566
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Authorized Official
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Title or Position | OWNER / SPEECH LANGUAGE PATHOLOGIST
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Name | MS. TRACY ANDREW
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Credential | MS, CCC-SLP
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Telephone | 888-545-2566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 15011
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License Number State | CA
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