Individual
JEANNA BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1238 W MAIN ST, MASCOUTAH, IL 62258-1060
(618) 328-8008
Mailing address
1238 W MAIN ST, MASCOUTAH, IL 62258-1060
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
02/11/2017
Last updated
02/11/2017
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