Provider Demographics
NPI:1205527447
Name:BRADLEY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W18105 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-8647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LSS WI UP MI
Practice Address - Street 2:W18105 HEMLOCK RD
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499
Practice Address - Country:US
Practice Address - Phone:715-253-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator