Provider Demographics
NPI:1801429378
Name:BRADLEY J REDEKER, LMSW, LLC
Entity type:Organization
Organization Name:BRADLEY J REDEKER, LMSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDEKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, APBCC, CCTP
Authorized Official - Phone:616-258-0687
Mailing Address - Street 1:5510 LILLY CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9204
Mailing Address - Country:US
Mailing Address - Phone:616-258-0687
Mailing Address - Fax:
Practice Address - Street 1:3280 E BELTLINE CT NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9494
Practice Address - Country:US
Practice Address - Phone:616-610-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty