Provider Demographics
NPI:1902304579
Name:BLEDSOE, ASHLEY E (BSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:E
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:1050 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2007
Mailing Address - Country:US
Mailing Address - Phone:716-856-9711
Mailing Address - Fax:716-856-5614
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2007
Practice Address - Country:US
Practice Address - Phone:716-856-9711
Practice Address - Fax:716-856-5614
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)