Organization
WILLOW BLOOM THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LESLIE WANDEMBERG M.A., CCC-SLP (OWNER/PARTNER)
(575) 571-0326
Entity
Organization
Contact information
Practice address
70 HORSESHOE CIR, LAS CRUCES, NM 88007-4579
(575) 571-0326
Mailing address
1070 BOLING LN, LAS CRUCES, NM 88007-4868
(575) 571-0326
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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