Provider Demographics
NPI:1174775118
Name:NEWBY-BRISKER, DORIS
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:NEWBY-BRISKER
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 1:12735 HOYNE AVE
Mailing Address - Street 2:2E
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2282
Mailing Address - Country:US
Mailing Address - Phone:708-841-0347
Mailing Address - Fax:708-260-9396
Practice Address - Street 1:12735 HOYNE AVE
Practice Address - Street 2:2E
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2282
Practice Address - Country:US
Practice Address - Phone:708-841-0347
Practice Address - Fax:708-260-9396
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist