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General NPI Number Information
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NPI Number | 1164232336
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Entity Type | Organization
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Legal Business Name | THERABLOOM, LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 6376 CLORE LN
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City | CRESTWOOD
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State | KY
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Zip | 40014-8042
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Country | US
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Telephone | 260-437-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 9462 BROWNSBORO RD # 102
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City | LOUISVILLE
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State | KY
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Zip | 40241-1118
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Country | US
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Telephone | 260-437-8918
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Fax |
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Authorized Official
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Title or Position | SLP/OWNER
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Name | CAROLYN LUCKETT
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Credential | MS, CCC-SLP
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Telephone | 260-437-8918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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