Provider Demographics
NPI:1689171449
Name:BEDARD, JILL M (LMBT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:BEDARD
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2200
Mailing Address - Country:US
Mailing Address - Phone:970-663-6142
Mailing Address - Fax:970-635-3087
Practice Address - Street 1:2211 S COLLEGE AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1491
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-488-2850
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist