Provider Demographics
NPI:1447447107
Name:BRADTKE, JENNIFER ANN (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:BRADTKE
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EASTGATE STREET
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:STAFFORDSHIRE
Mailing Address - Zip Code:ST16 2LZ
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 EASTGATE STREET
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:STAFFORDSHIRE
Practice Address - Zip Code:ST16 2LZ
Practice Address - Country:GB
Practice Address - Phone:312-219-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPY495103TC0700X
IN20042723A103TC0700X
IL071.007336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical