Provider Demographics
NPI:1467032177
Name:BLEDSOE, TERESA JEAN (LIMHP PLADC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JEAN
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:LIMHP PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3630
Mailing Address - Country:US
Mailing Address - Phone:402-717-5550
Mailing Address - Fax:402-717-5792
Practice Address - Street 1:415 S 25TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3630
Practice Address - Country:US
Practice Address - Phone:402-717-5550
Practice Address - Fax:402-717-5792
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2111101YA0400X
NE2744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2744Medicaid