Provider Demographics
NPI:1033665294
Name:BRADLEY, MICHELLE K (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:K
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 APLIN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-9244
Mailing Address - Country:US
Mailing Address - Phone:615-364-0274
Mailing Address - Fax:
Practice Address - Street 1:214 APLIN BRANCH RD
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-9244
Practice Address - Country:US
Practice Address - Phone:615-364-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY#139062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist