=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992569040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BLUE DOOR INFANT AND MATERNAL WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2024
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 STARKEY BLVD STE 272
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-2175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-445-9006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19103 BECKETT DR
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33556-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-445-9006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | RACHEL HUDSON
-----------------------------------------------------
Credential | MA, CCC-SLP, IBCLC
-----------------------------------------------------
Telephone | 339-445-9006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------