Provider Demographics
NPI:1588687370
Name:BEDSOLE, LINDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:BEDSOLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N. ROUTE 31
Mailing Address - Street 2:SUITE E
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3715
Mailing Address - Country:US
Mailing Address - Phone:815-444-8469
Mailing Address - Fax:815-479-1709
Practice Address - Street 1:610 N. ROUTE 31
Practice Address - Street 2:SUITE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3715
Practice Address - Country:US
Practice Address - Phone:815-444-8469
Practice Address - Fax:815-479-1709
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632073OtherBLUECROSS/BLUESHIELD
IL614750Medicare PIN