Organization
BLOSSOM WELL
Active
Organization
BLOSSOM WELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY LEWIS (OWNER)
(708) 632-1090
Entity
Organization
Contact information
Practice address
142 W 62ND ST, CHICAGO, IL 60621-3809
(708) 632-1090
Mailing address
4193 W CRESTLINE ST, CHICAGO, IL 60652-2923
(708) 632-1090
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
171R00000X
Interpreter
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
07/06/2024
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