Provider Demographics
NPI:1093936619
Name:BRADLEY, ALLISON ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ELIZABETH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1821
Mailing Address - Country:US
Mailing Address - Phone:503-284-1906
Mailing Address - Fax:
Practice Address - Street 1:3502 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1821
Practice Address - Country:US
Practice Address - Phone:503-284-1906
Practice Address - Fax:503-546-0894
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21970231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226395Medicaid