Provider Demographics
NPI:1740007087
Name:BLOOMING IMAGINATIONS SPEECH THERAPY SERVICES LLC
Entity type:Organization
Organization Name:BLOOMING IMAGINATIONS SPEECH THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:406-936-0212
Mailing Address - Street 1:10555 SLEEMAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8515
Mailing Address - Country:US
Mailing Address - Phone:208-993-1809
Mailing Address - Fax:
Practice Address - Street 1:10555 SLEEMAN CREEK RD
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8515
Practice Address - Country:US
Practice Address - Phone:406-936-0212
Practice Address - Fax:406-290-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty