Individual
BRADLEY ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
5650 N GREEN BAY AVE STE 205, GLENDALE, WI 53209-4446
(262) 678-9119
Mailing address
N28W6284 ALYCE ST APT 233, CEDARBURG, WI 53012-2741
(414) 937-1073
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5165-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154665214
—
WI
Enumeration date
11/15/2012
Last updated
02/24/2025
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