Provider Demographics
NPI:1578737946
Name:BEDDOE, MARY E (LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BEDDOE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7109
Mailing Address - Country:US
Mailing Address - Phone:206-618-0142
Mailing Address - Fax:
Practice Address - Street 1:404 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7109
Practice Address - Country:US
Practice Address - Phone:206-618-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist