Bloom Center for Pediatric Therapy, LLC
Organization Active NPI Speech-Language Pathologist · Pocatello, ID
NPI 1215397666 · NPPES record last updated Apr 16, 2026
Key facts
- NPI
- 1215397666
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP-2171 (ID)
- Legal business name
- BLOOM CENTER FOR PEDIATRIC THERAPY, LLC
- Practice address
- 7677 W Portneuf Rd
Pocatello, ID 83204-7336 - Phone
- (208) 604-6260
- NPI assigned
- Feb 27, 2016
- Organization subpart
- No
Authorized official
- Name
- Mrs. Michelle Lee Lance, M.S. CCC-SLP
- Title
- Owner/Speech Language Pathologist
- Phone
- (208) 604-6260
Practitioners 12
-
Michelle Lee Lance, SLP
-
Melissa Merrill Arrington, DPT, ATC
-
Krystal L Schiess, M.S. CCC-SLP
-
Caitlin Fovenyessy, DPT
-
Lindsay Dawn Green, SLP
-
Derrick Northrup, P.T.
-
Holly Maurine St. John, MOTR/L
-
Krista Jean Hale, MS SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260221000439 | ID | Part B Supplier - Clinic/Group Practice | 7113408782 |
Receives reassigned benefits from 9 practitioners Practice locations: Pocatello, ID |
National Provider Directory
Locations
7677 W Portneuf Rd
Pocatello, ID 83204
Phone (208) 232-4679
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X | SLP-2171 | ID | Yes |
Addresses
Primary practice location
7677 W Portneuf Rd
Pocatello, ID 83204-7336
Mailing address
7677 W Portneuf Rd
Pocatello, ID 83204-7336
Phone (208) 604-6260
Other providers in Pocatello, ID
- Sierra Blasdel
- Easton Blevin
- Robert Blevin
- Nicholas James Blight
- Sheena Blocker
- Camille R Bloxham
- Richard Bloxham
- Brandie Bluemel
- BMH Inc
- BMH Inc
All providers in Pocatello, ID · Speech-Language Pathologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.