Provider Demographics
NPI:1386442069
Name:BRADFORD, KALE LEAN
Entity type:Individual
Prefix:
First Name:KALE
Middle Name:LEAN
Last Name:BRADFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SHEFFIELD AVE LOT 377
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46327-1047
Mailing Address - Country:US
Mailing Address - Phone:219-200-6727
Mailing Address - Fax:
Practice Address - Street 1:4840 GRASSELLI ST
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3503
Practice Address - Country:US
Practice Address - Phone:219-397-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician