Provider Demographics
NPI:1376303164
Name:BEDOYA, ALEXIE
Entity Type:Individual
Prefix:
First Name:ALEXIE
Middle Name:
Last Name:BEDOYA
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 1:4843 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5125
Mailing Address - Country:US
Mailing Address - Phone:312-623-7653
Mailing Address - Fax:
Practice Address - Street 1:8145 RIVER DR STE 101
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2645
Practice Address - Country:US
Practice Address - Phone:224-270-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst