MEDICARE: BLOSSOM THERAPY LLC

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	:	1770472292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM THERAPY LLC

Provider Business Mailing Address
First Line	:	218 BEVERLY DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 S COLLEGE RD STE 215
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3213
Country	:	US
Telephone Number	:	337-264-2600
Fax Number	:	337-451-0349

Authorized Official
Title or Position	:	SPEECH THERAPIST
Name	:	MRS. KELLY ANN LELEUX
Credential	:
Telephone Number	:	732-618-2667

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	03/16/2026

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Directions to “BLOSSOM THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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