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NPI Code Detail

MEDICARE: MRS. SUZANNE D BLEDSOE MS CCC-SLP

MEDICARE: MRS. SUZANNE D BLEDSOE MS CCC-SLP
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
1235Z00000XSpeech-Language Pathologist1823AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386868396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUZANNE D BLEDSOE MS CCC-SLP
Provider Business Mailing Address
First Line : 11985 HAYNESVILLE HWY
Second Line :
City : JUNCTION CITY
State : AR
Zip : 71749-8923
Country : US
Telephone Number : 870-599-9060
Fax Number :
Provider Business Practice Location Address
First Line : 214 HOPE LANDING RD
Second Line :
City : EL DORADO
State : AR
Zip : 71730-8725
Country : US
Telephone Number : 870-862-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 05/16/2008

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