Provider Demographics
NPI:1184785255
Name:BLEDSOE, MARK L
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:BLEDSOE
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:PO BOX 4334
Mailing Address - Street 2:
Mailing Address - City:YANKEE HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95965
Mailing Address - Country:US
Mailing Address - Phone:530-532-7814
Mailing Address - Fax:
Practice Address - Street 1:260 COHASSET ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-895-6650
Practice Address - Fax:530-895-6597
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator