MEDICARE: BLOOM SPEECH AND LANGUAGE THERAPY

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	108966	TX

General Provider Information

NPI Number	:	1700236684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM SPEECH AND LANGUAGE THERAPY

Provider Business Mailing Address
First Line	:	6916 LA MANGA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-2908
Country	:	US
Telephone Number	:	915-443-3499
Fax Number	:

Provider Business Practice Location Address
First Line	:	6916 LA MANGA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-2908
Country	:	US
Telephone Number	:	915-443-3499
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	LAURA FRIEDMAN
Credential	:	M.S., CCC-SLP
Telephone Number	:	915-443-3499

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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Directions to “BLOOM SPEECH AND LANGUAGE THERAPY ” Practice Location

Language	Start Address	Practice Location

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