Provider Demographics
NPI:1184025041
Name:BLIZZARD, BRITTANY MANN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MANN
Last Name:BLIZZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 OAK STUMP RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7604
Mailing Address - Country:US
Mailing Address - Phone:252-312-6248
Mailing Address - Fax:
Practice Address - Street 1:664 OAK STUMP RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7604
Practice Address - Country:US
Practice Address - Phone:252-312-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist