Inbloom Autism

Primary specialty

Child Mental Illness Respite CareTaxonomy code 385HR2055X

Legal business name

INBLOOM AUTISM

Practice address

200 N Patrick Blvd Ste
Brookfield, WI 53045-5883

Phone

(888) 754-0398

NPI assigned

Oct 9, 2023

Organization subpart

No

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

Authorized official

Name

Mya Edwards

Title

Behavior Therapist

Phone

(920) 512-4890

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1487435236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363 N 40TH ST APT 5",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532082857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N PATRICK BLVD STE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455883",
            "telephone_number": "888-754-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INBLOOM AUTISM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "MYA",
        "authorized_official_title_or_position": "BEHAVIOR THERAPIST",
        "authorized_official_telephone_number": "920-512-4890"
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Child Mental Illness Respite Care in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Child Mental Illness Respite Care in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.