Active NPI
Ryan Bradley, PSYD
- Clinical Psychologist
- Gurnee, IL
National Provider Identifier
1700187036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-008896
- Practice address
- 5465 Grand Ave
Gurnee, IL 60031-4913 - Phone
- (847) 356-3322
- NPI assigned
- Nov 3, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071-008896 | IL | Primary |
| Social Worker | 104100000X |
Addresses
Primary practice location
5465 Grand Ave
Gurnee, IL 60031-4913
Mailing address
420 W. Grand Ave.
Lake Villa, IL 60046
Phone (847) 356-3322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-008896 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1700187036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W. GRAND AVE.",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "60046",
"telephone_number": "847-356-3322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5465 GRAND AVE",
"city": "GURNEE",
"state": "IL",
"postal_code": "600314913",
"telephone_number": "847-356-3322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-03",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-008896",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.