Provider Demographics
NPI:1275797441
Name:BLEDSOE, LYNETTE YVONNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:YVONNE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 S HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6711
Mailing Address - Country:US
Mailing Address - Phone:850-712-6901
Mailing Address - Fax:
Practice Address - Street 1:2161 S HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6711
Practice Address - Country:US
Practice Address - Phone:850-712-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical