Provider Demographics
NPI:1578601530
Name:BLISS, ANN MARY (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARY
Last Name:BLISS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MILLDOWN RD
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-9770
Mailing Address - Country:US
Mailing Address - Phone:631-447-5447
Mailing Address - Fax:631-345-3972
Practice Address - Street 1:23 MILLDOWN RD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-9770
Practice Address - Country:US
Practice Address - Phone:631-447-5447
Practice Address - Fax:631-345-3972
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist