Provider Demographics
NPI:1992053169
Name:BRADSHAW PSYCHOLGICAL SERVICES
Entity type:Organization
Organization Name:BRADSHAW PSYCHOLGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:1ST GOV
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:RN CNP
Authorized Official - Phone:952-892-7690
Mailing Address - Street 1:7637 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5600
Mailing Address - Country:US
Mailing Address - Phone:952-892-7690
Mailing Address - Fax:952-898-4930
Practice Address - Street 1:1751 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7012
Practice Address - Country:US
Practice Address - Phone:952-892-7690
Practice Address - Fax:952-898-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health