Individual
KELLY BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 DONALD AVE, INDEPENDENCE, KS 67301-2001
(620) 331-1748
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
995
KS
1041C0700X
Clinical Social Worker
Primary
4705
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200875750A
—
KS
Enumeration date
06/14/2012
Last updated
08/28/2017
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