NPIMap

Organization Active NPI

Bloom Pediatric Therapy

  • Speech-Language Pathologist
  • Mount Juliet, TN
National Provider Identifier
1831894815
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BLOOM PEDIATRIC THERAPY
Practice address
2730 N Mount Juliet Rd
Mount Juliet, TN 37122-8018
Phone
(615) 208-4849
NPI assigned
Mar 31, 2023
Last updated
Sep 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Authorized official

Name
Kelcy Victoria Bonham, SLP, CLCNPI 1841943958
Title
Owner
Phone
(615) 208-4849

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
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary
Hearing and Speech Clinic/Center 261QH0700X NU
Lactation Consultant (Non-RN) 174N00000X NU

Addresses

Primary practice location

2730 N Mount Juliet Rd
Mount Juliet, TN 37122-8018

Mailing address

2730 N Mount Juliet Rd
Mount Juliet, TN 37122-8018
Phone (615) 208-4849

National Provider Directory

National Provider Directory

Locations

2730 N Mount Juliet Rd
Mt Juliet, TN 37122
Phone (615) 208-4849

541 N Mount Juliet Rd
Ste 2201A
Mt Juliet, TN 37122
Phone (615) 208-4849

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1831894815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 N MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228018",
            "telephone_number": "615-208-4849",
            "fax_number": "615-208-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 N MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228018",
            "telephone_number": "615-208-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-31",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "BONHAM",
        "authorized_official_first_name": "KELCY",
        "authorized_official_middle_name": "VICTORIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-208-4849",
        "authorized_official_credential": "SLP, CLC"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.