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General NPI Number Information
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NPI Number | 1114391828
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Entity Type | Individual
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Provider Name | KEVIN BRADFORD A.S. C.A.D.C
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Gender | Male
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 1607 NW PRAIRIE LAKES DR UNIT 212
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City | ANKENY
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State | IA
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Zip | 50023-4819
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Country | US
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Telephone | 402-840-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 1607 NW PRAIRIE LAKES DR.UNIT 212
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City | ANKENY
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State | IA
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Zip | 50023
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Country | US
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Telephone | 402-840-7288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15094
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License Number State | IA
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