Organization
INBLOOM AUTISM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYA EDWARDS (BEHAVIOR THERAPIST)
(920) 512-4890
Entity
Organization
Contact information
Practice address
200 N PATRICK BLVD STE, BROOKFIELD, WI 53045-5883
(888) 754-0398
Mailing address
1363 N 40TH ST APT 5, MILWAUKEE, WI 53208-2857
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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