Provider Demographics
NPI:1093468829
Name:BEDARD, JONATHAN PAUL (DSP, CRMA, CPR)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:BEDARD
Suffix:
Gender:M
Credentials:DSP, CRMA, CPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 QUIMBY ST APT 102
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-5226
Mailing Address - Country:US
Mailing Address - Phone:207-229-8959
Mailing Address - Fax:
Practice Address - Street 1:27 QUIMBY ST APT 102
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-5226
Practice Address - Country:US
Practice Address - Phone:207-229-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker