Healthcare Provider Details

I. General information

NPI: 1003729666
Provider Name (Legal Business Name): JORDAN BEDARD-CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W MAIN ST
ELKTON MD
21921-5541
US

IV. Provider business mailing address

629 CONNELLY RD
RISING SUN MD
21911-1006
US

V. Phone/Fax

Practice location:
  • Phone: 410-996-4878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18585
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: