Individual
DR. BRIAN WILLIAM BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
101 FALLS RD, SUITE 404, GRAFTON, WI 53024-2612
(262) 375-8441
(262) 546-0005
Mailing address
101 FALLS RD, SUITE 404, GRAFTON, WI 53024-2612
(262) 375-8441
(262) 546-0005
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
868
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39050200
—
WI
01
—
868
PSYCHOLOGY LICENSE NUMBER
WI
Enumeration date
01/02/2007
Last updated
07/08/2007
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