Healthcare Provider Details

I. General information

NPI: 1174019913
Provider Name (Legal Business Name): KASEY BEDARD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NE BOULEVARD
GAINESVILLE FL
32601-5467
US

IV. Provider business mailing address

425 NE BOULEVARD
GAINESVILLE FL
32601-5467
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-5797
  • Fax:
Mailing address:
  • Phone: 954-907-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19632
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: