Provider Demographics
NPI:1750802708
Name:BLEDSOE, KARLEY JORDAN (BCBA)
Entity type:Individual
Prefix:
First Name:KARLEY
Middle Name:JORDAN
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 JEFFERSON ST APT 5114
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2417
Mailing Address - Country:US
Mailing Address - Phone:913-223-1338
Mailing Address - Fax:
Practice Address - Street 1:1224 JEFFERSON ST APT 5114
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2417
Practice Address - Country:US
Practice Address - Phone:913-223-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-26015103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst