Organization
BLOOM SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COURTNEY OLIVIA MARTIN MA,CCC-SLP (PRESIDENT)
(803) 260-6253
Entity
Organization
Contact information
Practice address
105 TOAD RD, COLUMBIA, SC 29209-3177
(803) 260-6253
(855) 202-0515
Mailing address
PO BOX 90702, COLUMBIA, SC 29290-1702
(803) 260-6253
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
251J00000X
Nursing Care Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA1908
—
SC
Enumeration date
05/26/2022
Last updated
05/26/2022
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