Provider Demographics
NPI:1740542240
Name:BLOSSOM MIDWIFERY LLC
Entity type:Organization
Organization Name:BLOSSOM MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:JECH
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:503-522-4545
Mailing Address - Street 1:4303 SE FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5077
Mailing Address - Country:US
Mailing Address - Phone:503-522-4545
Mailing Address - Fax:503-405-8286
Practice Address - Street 1:4303 SE FIELDCREST DR
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5077
Practice Address - Country:US
Practice Address - Phone:503-522-4545
Practice Address - Fax:503-405-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10121585176B00000X
OR201050147NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty