MEDICARE: MISS BLISS HICKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant		AZ

General Provider Information

NPI Number	:	1952257487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BLISS HICKMAN

Provider Business Mailing Address
First Line	:	4312 N VERRADO WAY
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 N VERRADO WAY
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-7533
Country	:	US
Telephone Number	:	623-980-5671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ MISS BLISS HICKMAN ” Practice Location

Language	Start Address	Practice Location

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