Provider Demographics
NPI:1841413010
Name:DIMENSIONS SPEECH LANGUAGE AND LEARNING SERVICES, NORTH
Entity Type:Organization
Organization Name:DIMENSIONS SPEECH LANGUAGE AND LEARNING SERVICES, NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:954-236-9415
Mailing Address - Street 1:8075 NW 15TH MNR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5453
Mailing Address - Country:US
Mailing Address - Phone:954-424-1630
Mailing Address - Fax:
Practice Address - Street 1:12545 ORANGE DR STE 502
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4306
Practice Address - Country:US
Practice Address - Phone:954-236-9415
Practice Address - Fax:954-236-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888506100Medicaid
FL09134279OtherASHA