Organization
BLOOM PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELCY VICTORIA BONHAM SLP, CLC (OWNER)
(615) 208-4849
Entity
Organization
Contact information
Practice address
2730 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-8018
(615) 208-4849
Mailing address
2730 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-8018
(615) 208-4849
(615) 208-5540
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
Other
Enumeration date
03/31/2023
Last updated
09/19/2024
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