Debra S Bledsoe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

29861 Florida Ave
Elkhart, IN 46516-1351

Phone

(574) 607-1110

Fax

(574) 607-1110

NPI assigned

Mar 13, 2007

Last updated

Jan 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Debra S Shively Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1831222827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29861 FLORIDA AVENUE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "46516",
            "telephone_number": "574-607-1110",
            "fax_number": "574-607-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29861 FLORIDA AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465161351",
            "telephone_number": "574-607-1110",
            "fax_number": "574-607-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "DEBRA",
        "middle_name": "S",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "SHIVELY",
            "middle_name": "S",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexis Bishop
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• Thomas Blaschke
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• Malee Blue
• Catherine C Blum, LCSW
• Mabel A. Blunk, M.D.
• Jan Michael Boehringer, OD

• Clinical Social Worker in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.