Provider Demographics
NPI:1700105566
Name:AS CHILDREN BLOSSOM THERAPY CENTER
Entity Type:Organization
Organization Name:AS CHILDREN BLOSSOM THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA OTR/L
Authorized Official - Phone:408-866-4700
Mailing Address - Street 1:621 E CAMPBELL AVE
Mailing Address - Street 2:SUITE 11A
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2139
Mailing Address - Country:US
Mailing Address - Phone:408-866-4700
Mailing Address - Fax:408-866-1700
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 11A
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-866-4700
Practice Address - Fax:408-866-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty