Provider Demographics
NPI:1851555726
Name:BRADACH, JANET LEA
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LEA
Last Name:BRADACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LEA
Other - Last Name:BJERKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26260 BUSCH DR
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-5119
Mailing Address - Country:US
Mailing Address - Phone:952-607-6509
Mailing Address - Fax:952-873-3845
Practice Address - Street 1:26260 BUSCH DR
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-5119
Practice Address - Country:US
Practice Address - Phone:952-607-6509
Practice Address - Fax:952-873-3845
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health