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General NPI Number Information
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NPI Number | 1780294322
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Entity Type | Organization
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Legal Business Name | CONNECT & BLOOM SPEECH THERAPY INC.
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 264 GOLF LINKS ST
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City | PLEASANT HILL
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State | CA
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Zip | 94523-5605
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Country | US
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Telephone | 509-499-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 264 GOLF LINKS ST
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City | PLEASANT HILL
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State | CA
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Zip | 94523-5605
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Country | US
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Telephone | 509-499-1981
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | JESSICA FLIKSTEEN
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Credential |
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Telephone | 925-326-1734
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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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