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General NPI Number Information
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NPI Number | 1487529616
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Entity Type | Organization
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Legal Business Name | BRIDGE & BLOOM SPEECH THERAPY, PC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 5933 OATFIELD AVE
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City | EASTVALE
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State | CA
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Zip | 92880-6407
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Country | US
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Telephone | 951-733-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 12495 LIMONITE AVE # 1059
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City | EASTVALE
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State | CA
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Zip | 91752-2457
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Country | US
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Telephone | 951-733-1220
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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 | KARISSA KENNEDY-CASTILLO
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Credential |
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Telephone | 951-733-1220
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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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