MEDICARE: BLOOM THERAPY COLLECTIVE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1134941669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM THERAPY COLLECTIVE PLLC

Provider Business Mailing Address
First Line	:	1772 ADEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5300
Country	:	US
Telephone Number	:	409-983-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 ADEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5300
Country	:	US
Telephone Number	:	409-983-0012
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CAITLIN ELIZABETH DELK
Credential	:
Telephone Number	:	409-983-0012

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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