MEDICARE: BRADLEY ROSS MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5165-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154665214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY ROSS MS, LPC

Provider Business Mailing Address
First Line	:	N28W6284 ALYCE ST APT 233
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2741
Country	:	US
Telephone Number	:	414-937-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 N GREEN BAY AVE STE 205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4446
Country	:	US
Telephone Number	:	262-678-9119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	02/24/2025

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