Provider Demographics
NPI:1881168474
Name:BRADFIELD, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRADFIELD
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 1:4555 SW 142ND AVE APT 4555SW
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2534
Mailing Address - Country:US
Mailing Address - Phone:503-960-3135
Mailing Address - Fax:
Practice Address - Street 1:4555 SW 142ND AVE APT 4555SW
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2534
Practice Address - Country:US
Practice Address - Phone:503-960-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0123456789Medicaid