Infinite Bloom Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INFINITE BLOOM THERAPY LLC

Practice address

2611 SW 17TH St
Topeka, KS 66604-2603

Phone

(785) 250-5002

NPI assigned

May 15, 2024

Last updated

Jun 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Krystal Kershaw, LSCSWNPI 1083143168

Title

Sole Proprietor

Phone

(785) 250-5002

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 2

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.

• Krystal Kershaw

  • Clinical Social Worker
  • Topeka, KS
  • NPI 1083143168
  Medicare reassignment NPD Authorized official
• Sheri R Daudet, LSCSW

  • Clinical Social Worker
  • Topeka, KS
  • NPI 1811156540
  NPD (past)

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1932958535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SW LINCOLN ST",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666041239",
            "telephone_number": "785-250-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 SW 17TH ST",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666042603",
            "telephone_number": "785-250-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITE BLOOM THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "KERSHAW",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "785-250-5002",
        "authorized_official_credential": "LSCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Topeka, KS
• Providers in Topeka, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.