NPI 1891020467 · live from the CMS NPI Registry
Lonnie Bradford, Psy.D
Clinical Neuropsychologist in Saint Cloud, MN. National Provider Identifier 1891020467, active.
NPI record
| NPI | 1891020467 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Clinical Neuropsychologist 103G00000X |
| Practice location | 3812 8th St N Ste 200, Saint Cloud, MN 56303 |
| Practice phone | 513-612-0876 |
| Enumerated | October 15, 2009 |
| Last updated | November 22, 2019 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical | 103TC0700X | 1673 (AL) |
| Clinical Neuropsychologist primary | 103G00000X | 6007 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.