Provider Demographics
NPI:1376647479
Name:BRADLEY/CLEVELAND DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:BRADLEY/CLEVELAND DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-472-5268
Mailing Address - Street 1:764 OLD CHATTANOOGA PK SW
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37364-0007
Mailing Address - Country:US
Mailing Address - Phone:423-472-5268
Mailing Address - Fax:
Practice Address - Street 1:764 OLD CHATTANOOGA PK SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37364-0007
Practice Address - Country:US
Practice Address - Phone:423-338-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2023-05-03
Deactivation Date:2022-02-18
Deactivation Code:
Reactivation Date:2023-05-03
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020193235500000X
TN11041235Z00000X
TN012009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty