Provider Demographics
NPI:1013692896
Name:BRADFORD, KATHRYN (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W GARLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2615
Mailing Address - Country:US
Mailing Address - Phone:509-596-1055
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-596-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61426052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health