Provider Demographics
NPI:1710760384
Name:BRADICICH, JUDY MICHELLE (RD, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MICHELLE
Last Name:BRADICICH
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 GRASSY KNLS
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5542
Mailing Address - Country:US
Mailing Address - Phone:713-553-6261
Mailing Address - Fax:
Practice Address - Street 1:67 GRASSY KNLS
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5542
Practice Address - Country:US
Practice Address - Phone:713-553-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered