Provider Demographics
NPI:1700355153
Name:BEDNAR, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PLYMOUTH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1842
Mailing Address - Country:US
Mailing Address - Phone:734-416-9098
Mailing Address - Fax:
Practice Address - Street 1:409 PLYMOUTH RD STE 250
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1842
Practice Address - Country:US
Practice Address - Phone:734-416-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017485103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling