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General NPI Number Information
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NPI Number | 1912446451
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Entity Type | Individual
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Provider Name | JACOB BEDUNA
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Gender | Male
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 500 S MORTON ST SUITE 010
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2460
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Country | US
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Telephone | 812-322-0313
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Fax | 812-610-1814
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Provider Business Mailing Address
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Address Line | 9900 GILMORE RIDGE RD
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City | NASHVILLE
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State | IN
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Zip | 47448-9731
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Country | US
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Telephone | 812-322-0313
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Fax | 812-610-1814
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-22847
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License Number State | IN
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