Provider Demographics
NPI:1962852731
Name:BLEDSOE, JOYCE (PSYCHIATRIC TECHNICI)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:PSYCHIATRIC TECHNICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BERCUT DR
Mailing Address - Street 2:SUITE # C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-0110
Mailing Address - Country:US
Mailing Address - Phone:916-441-3819
Mailing Address - Fax:916-441-8070
Practice Address - Street 1:630 BERCUT DR
Practice Address - Street 2:SUITE # C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0110
Practice Address - Country:US
Practice Address - Phone:916-441-3819
Practice Address - Fax:916-441-8070
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23648167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician