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General NPI Number Information
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NPI Number | 1255298535
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Entity Type | Organization
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Legal Business Name | BLOSSOMING MINDS PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1544 EUREKA RD STE 110
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City | ROSEVILLE
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State | CA
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Zip | 95661-3092
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Country | US
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Telephone | 650-549-5617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1979
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City | ROCKLIN
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State | CA
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Zip | 95677-7979
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Country | US
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Telephone | 650-549-5617
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. BRIDGET MARY WIECKOWSKI
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Credential | PSYD
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Telephone | 650-549-5617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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