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NPI Code Detail

MEDICARE: ERIN BRADLEY MS, BCBA

MEDICARE: ERIN BRADLEY MS, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-18-30087AZ

General Provider Information

NPI Number : 1245638758
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN BRADLEY MS, BCBA
Provider Business Mailing Address
First Line : 390 UNION BLVD STE 300
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-6514
Country : US
Telephone Number : 720-377-3158
Fax Number :
Provider Business Practice Location Address
First Line : 1 S CHURCH AVE STE 1200
Second Line :
City : TUCSON
State : AZ
Zip : 85701-1601
Country : US
Telephone Number : 855-824-5669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2014
Last Update Date : 11/07/2019

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