Organization
BLOOM SPEECH & NEURO REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLIE NIDIFFER-TULL MA., CCC-SLP (OWNER AND SLP)
(918) 869-6379
Entity
Organization
Contact information
Practice address
9422 S ELWOOD AVE STE 100, JENKS, OK 74037-2317
(918) 869-6379
(918) 627-7896
Mailing address
9422 S ELWOOD AVE STE 100, JENKS, OK 74037-2317
(918) 869-6379
(918) 627-7896
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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