MEDICARE: MS. ANNE MARIE BEDARD M.A., TLLP

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	6362009723	MI

General Provider Information

NPI Number	:	1962266122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE MARIE BEDARD M.A., TLLP

Provider Business Mailing Address
First Line	:	2757 BUTTERNUT CT
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1566
Country	:	US
Telephone Number	:	313-515-1305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 BUTTERNUT CT
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1566
Country	:	US
Telephone Number	:	313-515-1305
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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