Provider Demographics
NPI:1689445231
Name:COMMUNICATION BLOOMS SPEECH THERAPY INC.
Entity Type:Organization
Organization Name:COMMUNICATION BLOOMS SPEECH THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:209-242-4606
Mailing Address - Street 1:16966 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:CA
Mailing Address - Zip Code:95236-9751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 W KETTLEMAN LN STE 1
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4209
Practice Address - Country:US
Practice Address - Phone:209-242-4606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty