Provider Demographics
NPI:1770942294
Name:BRADLEY, DAYDRA DAWN (MSC/CIT)
Entity type:Individual
Prefix:
First Name:DAYDRA
Middle Name:DAWN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSC/CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 SE EAGLE CREEK RD UNIT 47
Mailing Address - Street 2:
Mailing Address - City:EAGLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97022-8607
Mailing Address - Country:US
Mailing Address - Phone:541-450-8335
Mailing Address - Fax:
Practice Address - Street 1:1427 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5008
Practice Address - Country:US
Practice Address - Phone:503-471-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)