Provider Demographics
NPI:1124042395
Name:BRADFORD, SHEA H (MSP/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:H
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MSP/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17535 SPRINGWINDS DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7740
Mailing Address - Country:US
Mailing Address - Phone:704-892-7906
Mailing Address - Fax:
Practice Address - Street 1:4022 CONNER GLENN DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6466
Practice Address - Country:US
Practice Address - Phone:704-992-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist