Individual
BEVERLY BRYAN BLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
10025 BEARD AVE S, BLOOMINGTON, MN 55431-2719
(952) 220-0535
Mailing address
10025 BEARD AVE S, BLOOMINGTON, MN 55431-2719
(952) 220-0535
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00746958
AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
—
01
—
8075
MINNESOTA DEPARTMENT OF HEALTH, SPEECH LANGUAGE PATHOLOGIST
MN
Enumeration date
05/18/2009
Last updated
05/18/2009
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