Provider Demographics
NPI:1528823416
Name:BRADLEY, BAILEY W (EDS, BCBA)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:W
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WALTER L DASHER RD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-3224
Mailing Address - Country:US
Mailing Address - Phone:912-237-8791
Mailing Address - Fax:
Practice Address - Street 1:243 HODGES ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-6096
Practice Address - Country:US
Practice Address - Phone:912-567-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst