Provider Demographics
NPI:1912238635
Name:REEDY, BRAD MICHAEL
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:MICHAEL
Last Name:REEDY
Suffix:
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 1:382 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84021-0318
Mailing Address - Country:US
Mailing Address - Phone:435-738-2040
Mailing Address - Fax:801-437-2984
Practice Address - Street 1:382 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84021-0318
Practice Address - Country:US
Practice Address - Phone:435-738-2040
Practice Address - Fax:801-437-2984
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT356639-39021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical