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General NPI Number Information
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NPI Number | 1396558920
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Entity Type | Organization
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Legal Business Name | AWAKEN AND BLOOM, LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1345 E 3900 S STE 102
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-4402
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Country | US
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Telephone | 385-279-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 356 E SAUNDERS ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-6015
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Country | US
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Telephone | 801-657-1476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER SEAY
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Credential | LAC
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Telephone | 801-657-1476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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