Provider Demographics
NPI:1902621501
Name:LADD, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:LADD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6620
Mailing Address - Country:US
Mailing Address - Phone:501-791-3331
Mailing Address - Fax:501-791-0294
Practice Address - Street 1:1900 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6620
Practice Address - Country:US
Practice Address - Phone:501-791-3331
Practice Address - Fax:501-791-0294
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician