Provider Demographics
NPI:1144730516
Name:BLEDSOE, ALICE MICHELLE (CDCA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MICHELLE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CARLL ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-2012
Mailing Address - Country:US
Mailing Address - Phone:513-872-8884
Mailing Address - Fax:
Practice Address - Street 1:1515 CARLL ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-2012
Practice Address - Country:US
Practice Address - Phone:513-872-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164444171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator