Provider Demographics
NPI:1821802109
Name:THE BLOOMING SPEECH CLINIC INC
Entity type:Organization
Organization Name:THE BLOOMING SPEECH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:925-469-8968
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-0117
Mailing Address - Country:US
Mailing Address - Phone:925-469-8968
Mailing Address - Fax:
Practice Address - Street 1:9010 BRENTWOOD BLVD STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4046
Practice Address - Country:US
Practice Address - Phone:925-469-8968
Practice Address - Fax:925-775-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty