=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629936620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JILL BRADLEY LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2026
-----------------------------------------------------
Last Update Date | 01/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4740 FLINTRIDGE DR STE 220L
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-4273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-459-9037
-----------------------------------------------------
Fax | 719-428-4592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4740 FLINTRIDGE DR STE 220L
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-4273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-459-9034
-----------------------------------------------------
Fax | 719-428-4592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | JILL MICHELLE BRADLEY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 719-459-9034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------