Individual
JESSICA BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, LADC, BCC
Contact information
Practice address
610 FLORENCE AVE, OWATONNA, MN 55060-4704
(507) 413-6084
Mailing address
201 3RD ST W, BOX 254, MANTORVILLE, MN 55955-8081
(507) 272-8446
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304221
MN
Other
Enumeration date
02/26/2017
Last updated
02/26/2017
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