Provider Demographics
NPI:1821895152
Name:BEDDOES, JONATHAN MAX
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MAX
Last Name:BEDDOES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 N AARON DR STE D
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8138
Mailing Address - Country:US
Mailing Address - Phone:435-244-7152
Mailing Address - Fax:
Practice Address - Street 1:1887 N AARON DR STE D
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8138
Practice Address - Country:US
Practice Address - Phone:435-244-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF25-117919171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator