Provider Demographics
NPI:1629738745
Name:SPEECH BLOSSOMS LLC
Entity Type:Organization
Organization Name:SPEECH BLOSSOMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALVREE
Authorized Official - Middle Name:SHANON
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, SLP-CCC
Authorized Official - Phone:803-747-5305
Mailing Address - Street 1:3384 MOUNT ZION RD APT 6105
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7878
Mailing Address - Country:US
Mailing Address - Phone:803-747-5305
Mailing Address - Fax:
Practice Address - Street 1:3384 MOUNT ZION RD APT 6105
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7878
Practice Address - Country:US
Practice Address - Phone:803-747-5305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty