Individual
MR. BRADLEY ROBERT NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MALP
Contact information
Practice address
215 SE 2ND AVE, GRAND RAPIDS, MN 55744-3615
(218) 326-1274
(218) 326-9787
Mailing address
215 SE 2ND AVE, GRAND RAPIDS, MN 55744-3615
(218) 326-1274
(218) 326-9787
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP0590
MN
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121052100
—
MN
01
—
160767
UCARE
MN
01
—
3032501
PREFERRED ONE
MN
01
—
4K585NE
BCBS
MN
01
—
6275968
MEDICA
MN
01
—
97026
HEALTH PARTNERS
MN
Enumeration date
07/14/2006
Last updated
01/31/2024
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