Healthcare Provider Details

I. General information

NPI: 1285553701
Provider Name (Legal Business Name): STEPHANI BRADLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 APARTMENT COURT DR, APT 123
BATON ROUGE LA
70806
US

IV. Provider business mailing address

246 APARTMENT COURT DR, APT 123
BATON ROUGE LA
70806
US

V. Phone/Fax

Practice location:
  • Phone: 318-302-0452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: