Provider Demographics
NPI:1306199245
Name:BRADFORD, JENNIFER W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:W
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 SONDRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3406
Mailing Address - Country:US
Mailing Address - Phone:214-507-1516
Mailing Address - Fax:
Practice Address - Street 1:8140 WALNUT HALL LANE
Practice Address - Street 2:SUITE 320
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:972-863-2232
Practice Address - Fax:972-474-9043
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17483101YP2500X
TX36341103T00000X
NJ35S100461900103T00000X
NY17357103T00000X
CA21637103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling