Provider Demographics
NPI:1780216119
Name:DESERT BLOSSOM SPEECH & LANGUAGE CENTER LLC
Entity Type:Organization
Organization Name:DESERT BLOSSOM SPEECH & LANGUAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:520-330-6108
Mailing Address - Street 1:7670 E BROADWAY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3779
Mailing Address - Country:US
Mailing Address - Phone:520-330-6108
Mailing Address - Fax:520-771-6692
Practice Address - Street 1:7670 E BROADWAY BLVD STE 303
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3779
Practice Address - Country:US
Practice Address - Phone:520-330-6108
Practice Address - Fax:520-771-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty