Provider Demographics
NPI:1780146225
Name:BEDARD, JESSICA ANNE (MED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BEDARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 N SHEFFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6737
Mailing Address - Country:US
Mailing Address - Phone:630-550-1414
Mailing Address - Fax:888-975-3791
Practice Address - Street 1:3343 N SHEFFIELD AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6737
Practice Address - Country:US
Practice Address - Phone:630-550-1414
Practice Address - Fax:888-975-3791
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist