Provider Demographics
NPI:1265981807
Name:BLOSSOM THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:BLOSSOM THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BENILDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:956-739-1795
Mailing Address - Street 1:1905 LAUREL OAK WAY
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7348
Mailing Address - Country:US
Mailing Address - Phone:956-739-1795
Mailing Address - Fax:956-587-0245
Practice Address - Street 1:1905 LAUREL OAK WAY
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7348
Practice Address - Country:US
Practice Address - Phone:956-739-1795
Practice Address - Fax:956-587-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty