Provider Demographics
NPI:1528727849
Name:BODEEN, JEFFREY LINK
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LINK
Last Name:BODEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HUNTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3653
Mailing Address - Country:US
Mailing Address - Phone:417-766-2391
Mailing Address - Fax:
Practice Address - Street 1:650 HUNTRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3653
Practice Address - Country:US
Practice Address - Phone:417-766-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program