Provider Demographics
NPI:1831222827
Name:BLEDSOE, DEBRA S (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:SHIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:29861 FLORIDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-607-1110
Mailing Address - Fax:574-607-1110
Practice Address - Street 1:29861 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-1351
Practice Address - Country:US
Practice Address - Phone:574-607-1110
Practice Address - Fax:574-607-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor