Provider Demographics
NPI:1669723656
Name:BRADLEY, ALISHA M
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
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 1:711 W GORDON TER
Mailing Address - Street 2:#318
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2274
Mailing Address - Country:US
Mailing Address - Phone:773-750-8108
Mailing Address - Fax:
Practice Address - Street 1:711 W GORDON TER
Practice Address - Street 2:#318
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2274
Practice Address - Country:US
Practice Address - Phone:773-750-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health