Provider Demographics
NPI:1063815009
Name:BLOOMQUIST, ALYSSA KULIK (MSP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:KULIK
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2559
Mailing Address - Country:US
Mailing Address - Phone:864-704-3021
Mailing Address - Fax:
Practice Address - Street 1:350 AUSTIN GRAYBILL RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9251
Practice Address - Country:US
Practice Address - Phone:803-278-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist