Individual
BRADLEY M VIVODA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
3301 N BALLARD RD, APPLETON, WI 54911-8928
(920) 733-4443
Mailing address
3301 N BALLARD RD, APPLETON, WI 54911-8928
(920) 733-4443
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12488-132
WI
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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