Provider Demographics
NPI:1386765550
Name:BRADLEY, JENNIFER KAY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KAY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4500 S LAKESHORE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7028
Mailing Address - Country:US
Mailing Address - Phone:480-379-2489
Mailing Address - Fax:480-345-2126
Practice Address - Street 1:4500 S LAKESHORE DR
Practice Address - Street 2:STE 300
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7028
Practice Address - Country:US
Practice Address - Phone:480-379-2489
Practice Address - Fax:480-345-2126
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical