Provider Demographics
NPI:1124398631
Name:MARTIN, BRADLEY A (CF-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HUMMINGBIRD CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8516
Mailing Address - Country:US
Mailing Address - Phone:870-897-0411
Mailing Address - Fax:870-932-0786
Practice Address - Street 1:509 HUMMINGBIRD CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8516
Practice Address - Country:US
Practice Address - Phone:870-897-0411
Practice Address - Fax:870-932-0786
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist