Provider Demographics
NPI:1548651045
Name:BRADSHAW, DOROTHY A
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
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 33
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-0033
Mailing Address - Country:US
Mailing Address - Phone:406-461-3232
Mailing Address - Fax:
Practice Address - Street 1:204 N SKAGIT ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1617
Practice Address - Country:US
Practice Address - Phone:360-325-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60372359101YM0800X
MTSWP-LCPC-LIC-4479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional