Healthcare Provider Details

I. General information

NPI: 1194993840
Provider Name (Legal Business Name): RACHEL MARIE BEDARD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MATHEWS ST
FORT COLLINS CO
80524-3722
US

IV. Provider business mailing address

1113 MATHEWS ST
FORT COLLINS CO
80524-3722
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-3950
  • Fax:
Mailing address:
  • Phone: 970-484-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: