Provider Demographics
NPI:1063052975
Name:O'BRIEN, BLISSAMBER SNOW WHITE
Entity type:Individual
Prefix:
First Name:BLISSAMBER
Middle Name:SNOW WHITE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-6124
Mailing Address - Country:US
Mailing Address - Phone:330-281-5072
Mailing Address - Fax:
Practice Address - Street 1:4090 E 93RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-5163
Practice Address - Country:US
Practice Address - Phone:216-838-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist