NPIMap

Organization Active NPI

Bloom and Grow Pediatric Therapy LLC

  • Speech-Language Pathologist
  • Charleston, SC
National Provider Identifier
1124764535
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BLOOM AND GROW PEDIATRIC THERAPY LLC
Practice address
208 Sawyer Cir Unit 413
Charleston, SC 29492-8624
Phone
(859) 229-0487
NPI assigned
May 9, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Shedden, SLP-CCCNPI 1154899573
Title
Owner
Phone
(859) 229-0487

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary
Hearing and Speech Clinic/Center 261QH0700X

Addresses

Primary practice location

208 Sawyer Cir Unit 413
Charleston, SC 29492-8624

Mailing address

208 Sawyer Cir Unit 413
Charleston, SC 29492-8624
Phone (859) 229-0487

Other identifiers 1

IdentifierTypeStateIssuer
SA2157MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1124764535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 SAWYER CIR UNIT 413",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294928624",
            "telephone_number": "859-229-0487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 SAWYER CIR UNIT 413",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294928624",
            "telephone_number": "859-229-0487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM AND GROW PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-09",
        "last_updated": "2022-05-09",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "SHEDDEN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-229-0487",
        "authorized_official_credential": "SLP-CCC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SA2157",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.