MEDICARE: MS. JENNIFER LYNN BEDFORD LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301013943	MI

General Provider Information

NPI Number	:	1083862957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN BEDFORD LLP

Provider Business Mailing Address
First Line	:	1525 CRYSTAL VALLEY CT SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-8118
Country	:	US
Telephone Number	:	616-634-0547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 E PARIS AVE SE STE 203
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2426
Country	:	US
Telephone Number	:	616-951-1132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	06/08/2026

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