Provider Demographics
NPI:1033852801
Name:BLOOM SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:BLOOM SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CONNEMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:414-687-5986
Mailing Address - Street 1:833 E GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1436
Mailing Address - Country:US
Mailing Address - Phone:414-687-5986
Mailing Address - Fax:
Practice Address - Street 1:1017 W GLEN OAKS LN STE 140
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3371
Practice Address - Country:US
Practice Address - Phone:414-533-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty