Provider Demographics
NPI:1194397547
Name:BEDFORD, LEXI MARIE
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:MARIE
Last Name:BEDFORD
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 1:1758 WESSEL CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3524
Mailing Address - Country:US
Mailing Address - Phone:815-503-2598
Mailing Address - Fax:
Practice Address - Street 1:309 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2767
Practice Address - Country:US
Practice Address - Phone:630-286-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician