Provider Demographics
NPI:1134440621
Name:BRADT, ALLISON RAE (BCBA, MS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RAE
Last Name:BRADT
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RAE
Other - Last Name:MCMANAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, MS
Mailing Address - Street 1:580 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2984
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-314-2442
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2984
Practice Address - Country:US
Practice Address - Phone:608-756-5555
Practice Address - Fax:608-314-2442
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst