Organization
BLOOM CENTER FOR PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE LEE LANCE M.S. CCC-SLP (OWNER/SPEECH LANGUAGE PATHOLOGIST)
(208) 604-6260
Entity
Organization
Contact information
Practice address
7677 W PORTNEUF RD, POCATELLO, ID 83204-7336
(208) 604-6260
Mailing address
7677 W PORTNEUF RD, POCATELLO, ID 83204-7336
(208) 604-6260
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SLP-2171
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417261645
MICHELLE LANCE
ID
01
—
1578871505
KRISTA HALE
ID
Enumeration date
02/27/2016
Last updated
04/16/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us