Provider Demographics
NPI:1669423448
Name:BEDNARZ, LINDA JOY (LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOY
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOY
Other - Last Name:FOTHERGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3435 EL DORADO CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-370-7531
Mailing Address - Fax:
Practice Address - Street 1:1675 WINTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-585-0351
Practice Address - Fax:503-585-0212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional