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NPI Code Detail

MEDICARE: JENNA BRADLEY B.A.

MEDICARE: JENNA BRADLEY B.A.
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1710769898
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA BRADLEY B.A.
Provider Business Mailing Address
First Line : 101 N BERRIEN ST APT 1
Second Line :
City : ALBION
State : MI
Zip : 49224-1587
Country : US
Telephone Number : 810-269-7629
Fax Number :
Provider Business Practice Location Address
First Line : 3769 QUARTON RD
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-4058
Country : US
Telephone Number : 248-894-1966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2023
Last Update Date : 10/16/2023

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