Provider Demographics
NPI:1083120919
Name:BRADSHAW, GRETCHEN (MS PSYCHOLOGY, CADC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MS PSYCHOLOGY, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-4823
Mailing Address - Country:US
Mailing Address - Phone:563-587-3614
Mailing Address - Fax:
Practice Address - Street 1:770 IOWA ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4823
Practice Address - Country:US
Practice Address - Phone:563-587-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23076101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1083120919Medicaid