| Blossom Children's Center- Canton | |
|
39453 Ford Rd Canton MI 48187-4320 | |
| (248) 277-3005 | |
| Not Available |
| Full Name | Blossom Children's Center- Canton |
|---|---|
| Speciality | Behavior Analyst |
| Location | 39453 Ford Rd, Canton, Michigan |
| Authorized Official Name and Position | Ziad Koza (CEO & FOUNDER) |
| Authorized Official Contact | 2482773005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Children's Center- Canton 44225 W 12 Mile Rd Ste C-106 Novi MI 48377-2640 | Blossom Children's Center- Canton 39453 Ford Rd Canton MI 48187-4320 Ph: (248) 277-3005 |
| NPI Number | 1437999257 |
|---|---|
| Provider Enumeration Date | 05/29/2024 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 8527503283 |
|---|---|
| Medicare Enrollment ID | O20240717003545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437999257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | () | Primary |
| 225XP0200X | Occupational Therapist - Pediatrics | () | Secondary |
| 235Z00000X | Speech-language Pathologist | () | Secondary |
| Provider Name | Shelby Klick |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1093692634 PECOS PAC ID: 6204303100 Enrollment ID: I20260429000440 |
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