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General NPI Number Information
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NPI Number | 1609253277
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Entity Type | Organization
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Legal Business Name | BLOOMING MINDS, INC
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Dates
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Enumeration Date | 05/02/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 1034 N 3RD ST SUITE 5B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3145
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Country | US
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Telephone | 208-713-3463
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 N 3RD ST SUITE 5B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3145
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Country | US
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Telephone | 208-713-3463
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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 | CRISTINA C STILES
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Credential | SLP, MS, CCC-SLP
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Telephone | 208-713-3463
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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 | SLP-2231
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License Number State | ID
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