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General NPI Number Information
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NPI Number | 1780794156
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Entity Type | Individual
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Provider Name | EVIE L BRADLEY MSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 543 TAYLOR AVE
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City | COLUMBUS
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State | OH
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Zip | 43203-1278
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Country | US
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Telephone | 614-257-5217
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Fax |
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Provider Business Mailing Address
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Address Line | 7709 DALGLEN CT
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2621
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Country | US
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Telephone | 614-866-5190
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-0002268
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License Number State | OH
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