Healthcare Provider Details

I. General information

NPI: 1437201878
Provider Name (Legal Business Name): DR BRAD S KAUDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 N MAIN ST
ASHLAND OR
97520-1752
US

IV. Provider business mailing address

PO BOX 873
ASHLAND OR
97520-0030
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-8988
  • Fax: 541-488-7977
Mailing address:
  • Phone: 541-488-8988
  • Fax: 541-488-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1537
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1537
License Number StateOR

VIII. Authorized Official

Name: DR. BRADLEY SCOTT KAUDER
Title or Position: OWNER
Credential: PSY.D.
Phone: 541-488-8988