Provider Demographics
NPI:1487406021
Name:BEDSON, JESSICA NICOLE (ATR-P, LCAS-A)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:BEDSON
Suffix:
Gender:F
Credentials:ATR-P, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19902 N COVE RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6571
Mailing Address - Country:US
Mailing Address - Phone:516-653-1900
Mailing Address - Fax:
Practice Address - Street 1:19902 N COVE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6571
Practice Address - Country:US
Practice Address - Phone:704-288-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22426225800000X
NC29490101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist