Provider Demographics
NPI:1578804449
Name:GROW AND BLOSSOM SPEECH AND LANGUAGE SERVICES, PLLC
Entity Type:Organization
Organization Name:GROW AND BLOSSOM SPEECH AND LANGUAGE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILINGUAL SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:718-440-7478
Mailing Address - Street 1:13529 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1037
Mailing Address - Country:US
Mailing Address - Phone:718-440-7478
Mailing Address - Fax:347-532-1315
Practice Address - Street 1:3427 STEINWAY ST
Practice Address - Street 2:SUITE 116
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-8606
Practice Address - Country:US
Practice Address - Phone:718-440-7478
Practice Address - Fax:347-532-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018511-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty