Provider Demographics
NPI:1215669114
Name:BRADFORD, VICTORIA RENEE (DOCTORAL EXTERN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:RENEE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DOCTORAL EXTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 N ARMOUR ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6104
Mailing Address - Country:US
Mailing Address - Phone:419-670-3203
Mailing Address - Fax:
Practice Address - Street 1:120 E OGDEN AVE STE 220
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3546
Practice Address - Country:US
Practice Address - Phone:630-325-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program