Lonnie Bradford, PSY.D

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6007 Issued in MN

Practice address

3812 8TH St N Ste 200
Saint Cloud, MN 56303-1421

Phone

(513) 612-0876

NPI assigned

Oct 15, 2009

Last updated

Nov 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1891020467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 8TH ST N STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031421",
            "telephone_number": "513-612-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 8TH ST N STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031421",
            "telephone_number": "513-612-0876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6900 Georgia Ave NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "203070003",
            "country_code": "US",
            "telephone_number": "202-782-0065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "LONNIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-15",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "6007",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "1673",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Christine Box
• Holly Boxell
• Philip F Boyle, M.D.
• Kelly Brabec, RN
• Kourtney N Bradford Seubert, MD
• Rachel Bradshaw, MSN
• Michael Scott Bragge, CRNA
• Brain Bleach Counseling PLLC
• Jaclyn Brambrink, RN
• Molly Lynn Branaugh, PHARMD

• Clinical Neuropsychologist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.