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Organization
BLOSSOMPATH LLC
Active
Organization
BLOSSOMPATH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASTAHO M ALI (OWNER)
(507) 530-7077
Entity
Organization
Contact information
Practice address
7630 145TH ST W STE 302, SAINT PAUL, MN 55124-7553
(507) 530-7077
Mailing address
7630 145TH ST W STE 302, SAINT PAUL, MN 55124-7553
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
06/27/2025
Last updated
06/27/2025
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