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NPI Code Detail

MEDICARE: DR. LYNN E BRADFORD PHD, HSPP

MEDICARE: DR. LYNN E BRADFORD PHD, HSPP
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
1103TC0700XClinical Psychologist20040774IN

Other Identifiers

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

General Provider Information

NPI Number : 1578508529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNN E BRADFORD PHD, HSPP
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line : STE 200
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number : 317-962-4836
Fax Number : 317-962-8646
Provider Business Practice Location Address
First Line : 2620 KESSLER BOULEVARD EAST DR
Second Line : SUITE 210
City : INDIANAPOLIS
State : IN
Zip : 46220-2890
Country : US
Telephone Number : 317-475-6200
Fax Number : 317-475-6212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 10/24/2007

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