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NPI Code Detail

MEDICARE: DAYDRA DAWN BRADLEY MSC/CIT

MEDICARE: DAYDRA DAWN BRADLEY MSC/CIT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1770942294
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAYDRA DAWN BRADLEY MSC/CIT
Provider Business Mailing Address
First Line : 25800 SE EAGLE CREEK RD UNIT 47
Second Line :
City : EAGLE CREEK
State : OR
Zip : 97022-8607
Country : US
Telephone Number : 541-450-8335
Fax Number :
Provider Business Practice Location Address
First Line : 1427 SE 182ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5008
Country : US
Telephone Number : 503-471-6005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2016
Last Update Date : 06/18/2019

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Directions to “ DAYDRA DAWN BRADLEY MSC/CIT” Practice Location

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