Provider Demographics
NPI:1417464751
Name:BLOSS, JILL YVONNE (BCBA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:YVONNE
Last Name:BLOSS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 EP TRUE PKWY APT 516
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5655
Mailing Address - Country:US
Mailing Address - Phone:515-321-1283
Mailing Address - Fax:
Practice Address - Street 1:1860 NW 118TH ST STE 100
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8278
Practice Address - Country:US
Practice Address - Phone:515-402-4130
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst