Provider Demographics
NPI:1033733035
Name:CHANG, BRADFORD KW (PHD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:KW
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6139 147TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4601
Mailing Address - Country:US
Mailing Address - Phone:425-533-8173
Mailing Address - Fax:
Practice Address - Street 1:13620 NE 20TH ST STE I
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4901
Practice Address - Country:US
Practice Address - Phone:425-533-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002048103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities