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General NPI Number Information
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NPI Number | 1730075474
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Entity Type | Organization
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Legal Business Name | BLOOM SPEECH & NEURO REHAB, LLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 9422 S ELWOOD AVE STE 100
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City | JENKS
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State | OK
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Zip | 74037-2317
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Country | US
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Telephone | 918-869-6379
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Fax | 918-627-7896
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Provider Business Mailing Address
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Address Line | 9422 S ELWOOD AVE STE 100
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City | JENKS
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State | OK
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Zip | 74037-2317
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Country | US
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Telephone | 918-869-6379
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Fax | 918-627-7896
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Authorized Official
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Title or Position | OWNER AND SLP
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Name | ASHLIE NIDIFFER-TULL
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Credential | MA., CCC-SLP
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Telephone | 918-869-6379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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