Healthcare Provider Details

I. General information

NPI: 1356264634
Provider Name (Legal Business Name): ANN MICHELLE BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 W SCOTT ST
FOND DU LAC WI
54935-2342
US

IV. Provider business mailing address

1160 LOCUST ST
OSHKOSH WI
54902-3204
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136295-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: