Provider Demographics
NPI:1407013170
Name:BLISS, JENNIFER K (PLPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:K
Last Name:BLISS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 HIGHWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-1332
Mailing Address - Country:US
Mailing Address - Phone:314-440-1283
Mailing Address - Fax:
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:314-440-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health