Provider Demographics
NPI:1093965568
Name:BRADFIELD, LORENA LUNA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:LUNA
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 APACHE AVE APT 607
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2322
Mailing Address - Country:US
Mailing Address - Phone:956-561-1576
Mailing Address - Fax:912-335-3528
Practice Address - Street 1:306 N MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2562
Practice Address - Country:US
Practice Address - Phone:912-320-4573
Practice Address - Fax:912-335-3528
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA258662410DMedicaid