Provider Demographics
NPI:1083631634
Name:BRADLEY, TRICIA LYNN (RD, LDN, MPH)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RD, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 W 95TH ST
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1686
Mailing Address - Country:US
Mailing Address - Phone:708-598-5913
Mailing Address - Fax:
Practice Address - Street 1:9120 W 95TH ST
Practice Address - Street 2:UNIT 3A
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1686
Practice Address - Country:US
Practice Address - Phone:708-598-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered