Provider Demographics
NPI:1366268260
Name:BEDARD, ALISON AINSWORTH
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:AINSWORTH
Last Name:BEDARD
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 1:5642 JONES ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-2304
Mailing Address - Country:US
Mailing Address - Phone:850-626-7779
Mailing Address - Fax:850-626-7171
Practice Address - Street 1:5642 JONES ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2304
Practice Address - Country:US
Practice Address - Phone:850-626-7779
Practice Address - Fax:850-626-7171
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health