Provider Demographics
NPI:1801192893
Name:BEDRIN, DAVID JOHN (MSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:BEDRIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-8022
Mailing Address - Country:US
Mailing Address - Phone:608-209-5105
Mailing Address - Fax:262-641-9791
Practice Address - Street 1:13105 W BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-8022
Practice Address - Country:US
Practice Address - Phone:608-209-5105
Practice Address - Fax:262-641-9791
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7594-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical