Provider Demographics
NPI:1245722172
Name:BRADT, ASHLEY VICTORIA (LPCC, LADC)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:VICTORIA
Last Name:BRADT
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-0023
Mailing Address - Country:US
Mailing Address - Phone:763-600-2911
Mailing Address - Fax:763-244-1243
Practice Address - Street 1:201 MAIN STREET W
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7163
Practice Address - Country:US
Practice Address - Phone:763-600-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty