MEDICARE: ISOBEL LEONCIA MARIE BRADACH

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1477321925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISOBEL LEONCIA MARIE BRADACH

Provider Business Mailing Address
First Line	:	6762 W SPRIGGEL ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4063
Country	:	US
Telephone Number	:	541-413-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	6762 W SPRIGGEL ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4063
Country	:	US
Telephone Number	:	541-413-0062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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Directions to “ ISOBEL LEONCIA MARIE BRADACH ” Practice Location

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