Provider Demographics
NPI:1053044842
Name:BRADEL-WARLICK, LAUREN (PHD, LP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BRADEL-WARLICK
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-0999
Mailing Address - Country:US
Mailing Address - Phone:320-245-6285
Mailing Address - Fax:
Practice Address - Street 1:2300 COUNTY ROAD 29
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5161
Practice Address - Country:US
Practice Address - Phone:320-245-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical