Individual
BRADLEY PHILLIP BOGDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
8441 STATE HIGHWAY 47 STE 1400, BRYAN, TX 77807-3208
(979) 776-8440
(877) 601-5854
Mailing address
2900 E 29TH ST STE 100, BRYAN, TX 77802-2623
(979) 436-0483
(877) 601-5854
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
361416602
—
TX
Enumeration date
10/17/2012
Last updated
07/15/2020
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