Provider Demographics
NPI:1104252626
Name:REDEKER, BRADLEY J (LMSW, APBCC, CCTP)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:J
Last Name:REDEKER
Suffix:
Gender:M
Credentials:LMSW, APBCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 LILLY CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9204
Mailing Address - Country:US
Mailing Address - Phone:616-610-9994
Mailing Address - Fax:
Practice Address - Street 1:3280 E BELTLINE CT NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9494
Practice Address - Country:US
Practice Address - Phone:616-610-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05879000104100000X
MI68010959321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker