Blossom Well

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BLOSSOM WELL

Practice address

142 W 62ND St
Chicago, IL 60621-3809

Phone

(708) 632-1090

NPI assigned

May 31, 2024

Organization subpart

No

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

Authorized official

Name

Tiffany Lewis

Title

Owner

Phone

(708) 632-1090

Specialties & licenses 4

Addresses

Locations

Practitioners 1

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

• Ashley Corbett

  • Counselor
  • Chicago, IL
  • NPI 1104785013

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720224000000",
    "number": "1750122198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4193 W CRESTLINE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606522923",
            "telephone_number": "708-632-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 W 62ND ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213809",
            "telephone_number": "708-632-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM WELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-07-06",
        "certification_date": "2024-07-06",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-632-1090"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Interpreter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Caroline Bloomquist, LSW
• Blossom Method LTD
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• Laura Marie Blount-Odum, O.D.
• Kiernan Sanderson Bloye
• Blue Bird Day LLC
• Blue Cardinal LLC
• Blue Diamond Health Care LLC

• Early Intervention Provider Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Early Intervention Provider Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2024; 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.