Provider Demographics
NPI:1407129786
Name:NEDEROSTEK, BRAD RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:RYAN
Last Name:NEDEROSTEK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 PARK GLEN RD
Mailing Address - Street 2:APARTMENT 132
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4783
Mailing Address - Country:US
Mailing Address - Phone:610-533-1911
Mailing Address - Fax:
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth