Blooming Connections Pediatric Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

BLOOMING CONNECTIONS PEDIATRIC THERAPY LLC

Practice address

3030 92ND Ave NE
Blaine, MN 55449-5624

Phone

(651) 269-5055

NPI assigned

Feb 27, 2024

Organization subpart

No

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

Authorized official

Name

Tracy Brynelsen

Title

Speech Language Pathologist

Phone

(651) 269-5055

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1306602248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 92ND AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 92ND AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495624",
            "telephone_number": "651-269-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMING CONNECTIONS PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BRYNELSEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "651-269-5055"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Blaine, MN
• Providers in Blaine, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.