Provider Demographics
NPI:1356534820
Name:BLISS, DOROTHY A (SLP/CCC/L)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:A
Last Name:BLISS
Suffix:
Gender:F
Credentials:SLP/CCC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22424 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1607
Mailing Address - Country:US
Mailing Address - Phone:708-748-2242
Mailing Address - Fax:
Practice Address - Street 1:22424 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1607
Practice Address - Country:US
Practice Address - Phone:708-748-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist