Provider Demographics
NPI:1639974579
Name:BRADLEY, PERCY DEE SR
Entity type:Individual
Prefix:MR
First Name:PERCY
Middle Name:DEE
Last Name:BRADLEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 MANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-1753
Mailing Address - Country:US
Mailing Address - Phone:531-215-4886
Mailing Address - Fax:
Practice Address - Street 1:2223 MANDERSON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-1753
Practice Address - Country:US
Practice Address - Phone:531-215-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker