Individual
SAGE BRADLEY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMLP
Contact information
Practice address
109 W 2ND ST STE A, OTTAWA, KS 66067-2212
(785) 242-2991
(785) 242-4401
Mailing address
1953 RENO RD, OTTAWA, KS 66067-8754
(785) 214-9338
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LMLP03376
KS
Other
Enumeration date
12/07/2021
Last updated
03/09/2025
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