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General NPI Number Information
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NPI Number | 1598587297
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Entity Type | Organization
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Legal Business Name | BLOOM BILINGUAL SPEECH THERAPY
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1201 EVANS AVE STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-5179
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Country | US
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Telephone | 682-207-1612
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 EVANS AVE STE 100 BOX NUMBER 12A
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City | FORT WORTH
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State | TX
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Zip | 76104-5179
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Country | US
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Telephone | 682-207-1612
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST- OWNER
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Name | MS. DIANA SERRANO
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Credential | M.S. CCC-SLP
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Telephone | 817-627-8471
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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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