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General NPI Number Information
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NPI Number | 1174071963
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Entity Type | Organization
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Legal Business Name | JENNIFER K BRADLEY, PSYD LLC
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 4500 S LAKESHORE DR STE 345
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City | TEMPE
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State | AZ
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Zip | 85282-7052
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Country | US
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Telephone | 480-917-3255
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Fax | 480-838-9022
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Provider Business Mailing Address
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Address Line | 4500 S LAKESHORE DR STE 345
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City | TEMPE
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State | AZ
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Zip | 85282-7052
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Country | US
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Telephone | 480-917-3255
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Fax | 480-838-9022
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JENNIFER K BRADLEY
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Credential | PSYD
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Telephone | 480-917-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3451
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License Number State | AZ
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