Provider Demographics
NPI:1346006277
Name:BRADLEY, HALEIGH MICHOLE
Entity type:Individual
Prefix:MRS
First Name:HALEIGH
Middle Name:MICHOLE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEIGH
Other - Middle Name:MICHOLE
Other - Last Name:JERNBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 ANNETTA AVE
Mailing Address - Street 2:
Mailing Address - City:HOYT
Mailing Address - State:KS
Mailing Address - Zip Code:66440-9605
Mailing Address - Country:US
Mailing Address - Phone:785-224-7630
Mailing Address - Fax:
Practice Address - Street 1:101 ANNETTA AVE
Practice Address - Street 2:
Practice Address - City:HOYT
Practice Address - State:KS
Practice Address - Zip Code:66440-9605
Practice Address - Country:US
Practice Address - Phone:785-224-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician