Provider Demographics
NPI:1336291707
Name:KAUDER, BRADLEY SCOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:KAUDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:S
Other - Last Name:KAUDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0030
Mailing Address - Country:US
Mailing Address - Phone:541-488-8988
Mailing Address - Fax:541-488-7977
Practice Address - Street 1:1875 HIGHWAY 99 N STE D
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9120
Practice Address - Country:US
Practice Address - Phone:541-488-8988
Practice Address - Fax:541-488-7977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1537103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
760722628OtherEIN NUMBER
ORR115648Medicare PIN
ORR115649Medicare PIN