Provider Demographics
NPI:1437201878
Name:DR BRAD S KAUDER LLC
Entity type:Organization
Organization Name:DR BRAD S KAUDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-488-8988
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0030
Mailing Address - Country:US
Mailing Address - Phone:541-488-8988
Mailing Address - Fax:541-488-7977
Practice Address - Street 1:739 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1752
Practice Address - Country:US
Practice Address - Phone:541-488-8988
Practice Address - Fax:541-488-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1537103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182024Medicaid
OR182024Medicaid
OR115648Medicare ID - Type UnspecifiedMEDICARE GROUP
OR115649Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL