Provider Demographics
NPI:1174019913
Name:BEDARD, KASEY (BCBA)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:BEDARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5467
Mailing Address - Country:US
Mailing Address - Phone:954-907-5797
Mailing Address - Fax:
Practice Address - Street 1:425 NE BOULEVARD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5467
Practice Address - Country:US
Practice Address - Phone:954-907-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-19632103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-19632OtherBOARD CERTIFIED BEHAVIOR ANALYST