Provider Demographics
NPI:1841595659
Name:BEDDOW, PETER A (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:BEDDOW
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRIAN CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4340
Mailing Address - Country:US
Mailing Address - Phone:615-403-8206
Mailing Address - Fax:
Practice Address - Street 1:100 BRIAN CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4340
Practice Address - Country:US
Practice Address - Phone:615-403-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst