Provider Demographics
NPI:1114391828
Name:BRADFORD, KEVIN (AS CADC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:AS CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 NW PRAIRIE LAKES DR.UNIT 212
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:402-840-7288
Mailing Address - Fax:
Practice Address - Street 1:1607 NW PRAIRIE LAKES DR
Practice Address - Street 2:UNIT 212
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4819
Practice Address - Country:US
Practice Address - Phone:402-840-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)