Provider Demographics
NPI:1902184948
Name:KIRKPATRICK, BRADLEY COLE (HAS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:COLE
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:3832 BAYMEADOWS RD
Practice Address - Street 2:STE 7
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-5605
Practice Address - Country:US
Practice Address - Phone:904-683-6923
Practice Address - Fax:904-683-6936
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4335237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610275100Medicaid