# BLOSSOM SPEECH AND LANGUAGE THERAPY TN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477354389
- **Authorized official:** MRS. MARYLYN LUCAS SLP (OWNER, SLP)
- **Authorized official phone:** (209) 404-0333

## Contact information

- **Practice address:** 5819 CHENAULT DR, MODESTO, CA 95356-9621
- **Practice address phone:** (209) 404-0333
- **Mailing address:** 5819 CHENAULT DR, MODESTO, CA 95356-9621
- **Mailing address phone:** (209) 404-0333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 235Z00000X | Speech-Language Pathologist | — | NULL | Yes |
| 235Z00000X | Speech-Language Pathologist | — | — | Yes |

## Other

- **Enumeration date:** 03/24/2025
- **Last updated:** 03/24/2025