Provider Demographics
NPI:1790025740
Name:BRADLEY, JESSICA LENAY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LENAY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:LENAY
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:2429 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2729
Mailing Address - Country:US
Mailing Address - Phone:360-734-2182
Mailing Address - Fax:360-752-2498
Practice Address - Street 1:2429 ELM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2729
Practice Address - Country:US
Practice Address - Phone:360-734-2182
Practice Address - Fax:360-752-2498
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60310658176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife