Organization
BLOSSOM TOWNE ENTERPRISES
Active
Other names
Illuminate
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON BLOSSOM (PRESIDENT)
(651) 264-0444
Entity
Organization
Contact information
Practice address
8615 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 264-0444
(651) 264-0447
Mailing address
8615 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 264-0444
(651) 264-0447
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP-1196
MN
Other
Enumeration date
06/26/2008
Last updated
06/26/2008
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