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1447447107 NPI number — JENNIFER ANN BRADTKE PSY.D., HSPP

NPI Number: 1447447107
Health Care Provider/Practitioner: JENNIFER ANN BRADTKE PSY.D., HSPP

Information about “1447447107” NPI (JENNIFER ANN BRADTKE PSY.D., HSPP) exists in 1447447107 in HTML format HTML  |  1447447107 in plain Text format TXT  |  1447447107 in PDF (Portable Document Format) PDF  |  1447447107 in an XML format XML  formats.

NPI Number : 1447447107 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447447107",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRADTKE",
    "FirstName": "JENNIFER",
    "MiddleName": "ANN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSY.D., HSPP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "33 EASTGATE STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STAFFORD",
    "MailingAddressStateName": "STAFFORDSHIRE",
    "MailingAddressPostalCode": "ST16 2LZ",
    "MailingAddressCountryCode": "GB",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "33 EASTGATE STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STAFFORD",
    "PracticeLocationAddressStateName": "STAFFORDSHIRE",
    "PracticeLocationAddressPostalCode": "ST16 2LZ",
    "PracticeLocationAddressCountryCode": "GB",
    "PracticeLocationAddressTelephoneNumber": "312-219-5520",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/26/2007",
    "LastUpdateDate": "09/23/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY-PSY-LIC-4851",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "20042723A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "TPPY495",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "071.007336",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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