Provider Demographics
NPI:1083888986
Name:BRADLEY, ERIN H (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:H
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11383 LUCKY DAN DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4774
Mailing Address - Country:US
Mailing Address - Phone:317-443-7556
Mailing Address - Fax:317-842-9500
Practice Address - Street 1:11383 LUCKY DAN DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4774
Practice Address - Country:US
Practice Address - Phone:317-443-7556
Practice Address - Fax:317-842-9500
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004410A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866640 AOtherLEGACY PROVIDER IDENTIFIER