Organization
BLOOM PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILY BROOKE BUNGER MCD, CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(803) 546-7140
Entity
Organization
Contact information
Practice address
169 HICKORY MEADOW RD, LEXINGTON, SC 29072-8883
(803) 546-7140
Mailing address
169 HICKORY MEADOW RD, LEXINGTON, SC 29072-8883
(803) 546-7140
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4150
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0823
—
SC
Enumeration date
12/13/2013
Last updated
12/13/2013
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