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General NPI Number Information
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NPI Number | 1205290145
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Entity Type | Organization
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Legal Business Name | BLEDSOE PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 1506 ANTHONY ST
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City | COLUMBIA
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State | MO
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Zip | 65201-5806
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Country | US
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Telephone | 573-499-1362
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Fax | 573-499-1362
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Provider Business Mailing Address
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Address Line | 1506 ANTHONY ST
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City | COLUMBIA
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State | MO
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Zip | 65201-5806
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Country | US
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Telephone | 573-499-1362
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Fax | 573-499-1362
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/OWNER
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Name | MS. MICHELLE C BLEDSOE
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Credential | BCBA
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Telephone | 573-499-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2013009323
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License Number State | MO
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