Provider Demographics
NPI:1326368317
Name:BLIEFERNICH, KRISTIN LOUISE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LOUISE
Last Name:BLIEFERNICH
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 1:17150 N BAY RD
Mailing Address - Street 2:APT. 2913
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3413
Mailing Address - Country:US
Mailing Address - Phone:845-701-9492
Mailing Address - Fax:
Practice Address - Street 1:2124 NE 123RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2881
Practice Address - Country:US
Practice Address - Phone:305-895-0444
Practice Address - Fax:305-895-0490
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist