Provider Demographics
NPI:1922821479
Name:BEZOLD, CORA
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:BEZOLD
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 1:460 S DEER RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2602
Mailing Address - Country:US
Mailing Address - Phone:309-575-3960
Mailing Address - Fax:309-575-3988
Practice Address - Street 1:460 S DEER RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2602
Practice Address - Country:US
Practice Address - Phone:309-575-3960
Practice Address - Fax:309-575-3988
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health