Provider Demographics
NPI:1790928760
Name:BLEDSOE, BERTHA H (LBSW)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:H
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-4504
Mailing Address - Country:US
Mailing Address - Phone:817-531-3866
Mailing Address - Fax:
Practice Address - Street 1:1825 W WALNUT HILL LN
Practice Address - Street 2:SUITE 120, ROOM 210
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3218
Practice Address - Country:US
Practice Address - Phone:214-426-7272
Practice Address - Fax:214-774-4602
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07565171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator