Organization
BLOOM PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN CANTRELL MA CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(740) 358-0007
Entity
Organization
Contact information
Practice address
1 AVALON RD, MOUNT VERNON, OH 43050-1403
(440) 725-3948
Mailing address
1105 E VINE ST, MOUNT VERNON, OH 43050-3658
(440) 725-3948
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
06/13/2021
Last updated
12/21/2021
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