Provider Demographics
NPI:1578027215
Name:BRADFORD, JESSICA KATE (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 ELAM RD APT F104
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6168
Mailing Address - Country:US
Mailing Address - Phone:615-605-9769
Mailing Address - Fax:
Practice Address - Street 1:916 HOLGATE CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6630
Practice Address - Country:US
Practice Address - Phone:615-335-7770
Practice Address - Fax:615-662-7170
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-16-14459106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty