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General NPI Number Information
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NPI Number | 1518460419
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Entity Type | Individual
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Provider Name | JESSICA RUTH YOST BLEDSOE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 8570 CYPRESS LAKE DR
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City | FORT MYERS
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State | FL
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Zip | 33919-5117
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Country | US
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Telephone | 863-225-2684
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Fax |
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Provider Business Mailing Address
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Address Line | 12601 KELLY PALM DR
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City | FORT MYERS
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State | FL
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Zip | 33908-5907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | FL
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