Provider Demographics
NPI:1619349461
Name:BEDELL, THEA M
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:M
Last Name:BEDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THEA
Other - Middle Name:
Other - Last Name:CURTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 5TH AVE SE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2464
Mailing Address - Country:US
Mailing Address - Phone:319-286-4545
Mailing Address - Fax:319-368-3358
Practice Address - Street 1:1030 5TH AVE SE
Practice Address - Street 2:SUITE 3000
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2464
Practice Address - Country:US
Practice Address - Phone:319-286-4545
Practice Address - Fax:319-368-3358
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078908101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor